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Herpes simplex - oral - Management
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How should I manage someone with gingivostomatitis?
- Reassure the individual or parent that gingivostomatitis (inflammation of the gums and mucous membranes of the mouth) is self limiting.
- Treat symptomatically:
- Offer paracetamol or ibuprofen to relieve pain and fever.
- Encourage adequate fluid intake to avoid dehydration.
- Consider offering topical benzydamine for additional pain relief.
- Offer chlorhexidine mouthwash to help control secondary infections and to control plaque accumulation if brushing of teeth is painful.
- The use of a lip barrier preparation (e.g. Vaseline®, Lypsyl®) may be useful to prevent lip adhesion.
- Provide advice to minimize transmission:
- Avoid touching the lesions, other than when applying medication.
- Wash hands with soap and water immediately after touching lesions.
- Avoid kissing until the lesions have completely healed.
- Do not share items that come into contact with lesion area (e.g. lipstick or lip gloss).
- Avoid oral sex until all lesions are completely healed.
- Children with gingivostomatitis who are generally well do not need to be excluded from nurseries and schools.
- Consider oral antivirals for immunocompetent individuals with severe gingivostomatitis. The optimum timing and dose of oral antiviral treatment are uncertain. Consider seeking specialist advice before prescribing.
- Seek specialist advice if:
- Symptoms are not improving after 5 days.
- The affected person is pregnant, a neonate, or is immunocompromised.
- Admit the person if they have difficulty drinking and are at risk of becoming dehydrated. Intravenous fluids may be required.
In depth
Prescriptions
Analgesia/antipyretic: use when required
Age from 1 month to 2 months
Paracetamol s/f susp: 30 to 60mg up to three times a day
Paracetamol 120mg/5ml oral suspension paediatric sugar free
Take 1.25ml to 2.5ml every 8 hours when required for relief of pain or high temperature. Maximum of three doses in 24 hours.
Supply 100 ml.
Ibuprofen s/f susp: 5mg/kg three to four times a day (> 5kg)
Ibuprofen 100mg/5ml oral suspension sugar free
*WEIGHT REQUIRED* Take 5mg per kg bodyweight three to four times a day when required to relieve pain or high temperature. Do not exceed the stated dose.
Supply 50 ml.
Age from 3 to 5 months
Ibuprofen s/f susp: 50mg three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take 2.5ml three times a day when required for relief of pain or high temperature. Do not exceed the stated dose.
Supply 50 ml.
Age from 3 to 11 months
Paracetamol s/f susp: 60 to 120mg up to four times a day
Paracetamol 120mg/5ml oral suspension paediatric sugar free
Take 2.5ml to 5ml every 4 to 6 hours when required for relief of pain or high temperature. Maximum of 4 doses in 24 hours.
Supply 150 ml.
Age from 6 to 11 months
Ibuprofen s/f susp: 50mg three to four times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take 2.5ml three to four times a day when required for relief of pain or high temperature. Do not exceed the stated dose.
Supply 100 ml.
Age from 1 year to 3 years 11 months
Ibuprofen s/f susp: 100mg three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take one 5ml spoonful three times a day when required for relief of pain or high temperature. Do not exceed the stated dose.
Supply 100 ml.
Age from 1 year to 5 years 11 months
Paracetamol s/f susp: 120mg to 240mg up to four times a day
Paracetamol 120mg/5ml oral suspension paediatric sugar free
Take one to two 5ml spoonfuls every 4 to 6 hours when required for relief of pain or high temperature. Maximum of 4 doses in 24 hours.
Supply 300 ml.
Age from 4 years to 6 years 11 months
Ibuprofen s/f susp: 150mg three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take 7.5ml three times a day when required for the relief of pain or high temperature. Do not exceed the stated dose.
Supply 150 ml.
Age from 6 years to 11 years 11 months
Paracetamol s/f susp: 250mg to 500mg up to four times a day
Paracetamol 250mg/5ml oral suspension sugar free
Take one to two 5ml spoonfuls every 4 to 6 hours when required for relief of pain or high temperature. Maximum of 4 doses in 24 hours.
Supply 300 ml.
Age from 7 years to 9 years 11 months
Ibuprofen s/f susp: 200mg three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take two 5ml spoonfuls three times a day when required for the relief of pain or high temperature. Do not exceed the stated dose.
Supply 300 ml.
Age from 10 years to 11 years 11 months
Ibuprofen s/f susp: 300mg three times a day
Ibuprofen 100mg/5ml oral suspension sugar free
Take three 5ml spoonfuls three times a day when required for the relief of pain or high temperature. Do not exceed the stated dose.
Supply 300 ml.
Age from 12 years to 17 years 11 months
Paracetamol tablets: 500mg to 1g up to four times a day
Paracetamol 500mg tablets
Take one or two tablets every 4 to 6 hours when required for relief of pain or high temperature. Maximum of 8 tablets in 24 hours.
Supply 50 tablets.
Ibuprofen tablets: 200mg to 400mg three to four times a day
Ibuprofen 200mg tablets
Take one or two tablets 3 to 4 times a day when required for relief of pain or high temperature. Do not exceed the stated dose.
Supply 56 tablets.
Age from 18 years onwards
Paracetamol tablets: 1g up to four times a day
Paracetamol 500mg tablets
Take two tablets every 4 to 6 hours when required for relief of pain or high temperature. Maximum of 8 tablets in 24 hours.
Supply 50 tablets.
Ibuprofen tablets: 400mg three or four times a day
Ibuprofen 400mg tablets
Take one tablet three or four times a day when required for relief of pain or high temperature. Do not exceed the stated dose.
Supply 28 tablets.
Local analgesic: benzydamine mouthwash or spray
Age from 5 years to 5 years 11 months
Benzydamine 0.15% spray: use 1 puff/4kg every 3 hours
Benzydamine 0.15% oromucosal spray
*WEIGHT REQUIRED* Spray one puff per 4kg bodyweight onto the affected area (up to a maximum of four sprays) every 3 hours when required for pain relief. Increase to every one and a half hours if required.
Supply 30 ml.
Age from 6 years to 12 years 11 months
Benzydamine 0.15% spray: use 4 sprays every 3 hours
Benzydamine 0.15% oromucosal spray
Spray four times onto the affected area every 3 hours when required for pain relief. Increase to every one and a half hours if required.
Supply 30 ml.
Age from 13 years onwards
Benzydamine 0.15% mouthwash: rinse with 15ml every 3 hours
Benzydamine 0.15% mouthwash
Rinse the mouth with 15ml every 3 hours when required for pain relief. Increase to every one and a half hours if required.
Supply 300 ml.
Benzydamine 0.15% spray: use 4 to 8 sprays every 3 hours
Benzydamine 0.15% oromucosal spray
Spray 4 to 8 times onto the affected area every 3 hours when required for pain relief. Increase to every one and a half hours if required.
Supply 30 ml.
Chlorhexidine mouthwash
Age from 7 years onwards
Chlorhexidine mouthwash: rinse with 10ml twice a day
Chlorhexidine gluconate 0.2% mouthwash
Rinse the mouth with 10ml for about 1 minute twice a day.
Supply 300 ml.
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