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Palliative cancer care - oral problems - Management
What antivirals are recommended?
- Topical aciclovir and topical penciclovir are recommended in immunocompetent people who are in the early stages of an uncomplicated herpes simplex infection in the locality of the lips.
- Oral aciclovir is recommended in:
- Immunocompetent people who are in the early stages of an intraoral herpes infection.
- All immunocompromised people whether herpes simplex infection is in the locality of the lips, or in the mouth.
[Doyle et al, 2004; Regnard and Hockley, 2004; Davies and Finlay, 2005]
Basis for recommendation
- Topical antiviral preparations are not recommended for treatment of intraoral herpes infection as they are difficult to apply, they may be irritant, and oral antivirals are more effective [Worrall, 2006].
- Oral antivirals are not usually needed in managing uncomplicated herpes simplex infection. There is limited evidence that oral aciclovir or valaciclovir can reduce the duration of symptoms by about one day if taken early in the attack (that is, at prodrome) [Jensen et al, 2004; Worrall, 2006]. Any effect on the duration of pain is very small [Spruance et al, 1990; Rooney et al, 1993; Whitley et al, 1998].
- Famciclovir is not licensed for the treatment of oral herpes simplex.
- Inosine pranobex tablets are licensed for the treatment of mucocutaneous herpes simplex, but there is little evidence of symptom relief or reduction in time to healing in immunocompetent people.
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