Opinion statement
-
Herpes simplex virus (HSV) infections are ubiquitous. Children are infected with HSV resulting in totally asymptomatic acquisition to life-threatening disease. Therapy of HSV diseases of children can be considered according to severity and time of acquisition [1].
-
Neonatal herpes simplex virus infections take one of three forms—disease localized to skin, eye, or mouth (SEM), encephalitis, or multiorgan disseminated disease. Treatment consists of intravenous (IV) administration of acyclovir. Supportive care for patients with life-threatening disease is an integral component of patient management.
-
Mucocutaneous HSV infections in the immunocompromised host can be treated with either intravenous acyclovir or one of the orally bioavailable antiviral therapies. For hospitalized patients, therapy consists of IV acyclovir at 5 mg/kg every 8 hours for 7 to 14 days. For ambulatory patients, therapy is tailored according to age. For children less than 12 years of age, oral acyclovir is administered at a dosage of 20 mg/kg every eight hours. Although no controlled studies have been performed with valaciclovir or famciclovir, the pharmacokinetics of these medications would suggest superiority over acyclovir. Dosage recommendations have not been established for young children. For postpubertal children, dosage should mirror that of adults. Valaciclovir is administered at 500 mg twice daily. Famciclovir is administered at 125 mg three times daily.
-
Herpes simplex keratoconjunctivitis is treated with topical triflurothymidine. Two drops are applied to the infected eye five times daily until resolved. Recurrences are managed in a similar manner. Some physicians administer oral acyclovir at the doses noted above in order to prevent frequent recurrences.
-
Genital HSV infections can be treated with acyclovir, valaciclovir, or famciclovir. Episodic treatment of recurrent episodes is usually not necessary in childhood. Importantly, all data on the use of these compounds for these conditions have been generated in adults.
-
Physician judgment is required for the management of recurrent herpes labialis, erythema multiforme, and herpes gladitorum. No controlled studies have been performed in children, although experience with acyclovir, valaciclovir, and famciclovir have resulted in their use.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References and Recommended Reading
Balfour HH, Jr: Antiviral drugs. N Engl J Med 1999, 340:1255–1268. Review of complete dosages of antiviral drugs.
Whitley RJ, Roizman B: Herpes simplex viruses: from structure to function. Lancet 2001, 357:1513.
Whitley RJ, Arvin A, Prober C, et al.: A controlled trial comparing vidarabine with acyclovir in neonatal herpes simplex virus infection. N Engl J Med 1991, 324:444–449. From 1991, the original controlled trial for antiviral therapy of neonatal herpes.
Whitley RJ, Arvin A, Prober C, et al.: Predictors of morbidity and mortality in neonates with herpes simplex virus infections. N Engl J Med 1991, 324:450–454.
Kimberlin DW, Lin C-Y, Jacobs RF, et al.: The safety and efficacy of high-dose intravenous acyclovir in the management of neonatal herpes simplex virus infections. Pediatrics 2001, 108:230–238. The controlled study established the safety and efficacy of high-dose acyclovir for neonatal herpes simplex virus
Kimberlin DW, Lin C-Y, Jacobs RF, et al.: Natural history of neonatal herpes simplex virus infections in the acyclovir era. Pedatrics 2001, 108:223–229. Provides an update of improvement of neonatal herpes simplex virus management.
Whitley RJ, Alford CA, Jr., Hirsch MS, et al.: Vidarabine versus acyclovir therapy in herpes simplex encephalitis. N Engl J Med 1986, 314:144–149.
Skoldenberg B, Forsgren M, Alestig K, et al.: Acyclovir versus vidarabine in herpes simplex encephalitis: a randomized multicentre study in consecutive Swedish patients. Lancet 1984, 2:707–711.
Whitley RJ, Kimberlin D: Antiviral Agents. In Gellis and Kagan’s Current Pediatric Therapy, vol 17. Edited by Burg FD, Ingelfinger JR, Polin RA, Gershon A. Philadelphia: WB Saunders; In press.
Ormrod D, Scott LJ, Perry CM: Valaciclovir: a review of its long term utility in the management of genital herpes simplex virus and cytomegalovirus infections. Drugs 2000, 59:839–863.
Perry CM, Faulds D: Valaciclovir: a review of its antiviral, pharmacokinetic properties and therapeutic efficacy in herpesvirus infections. Drugs 1996, 52:754–772.
Reitano M, Tyring SK, Lang W, et al.: Valaciclovir for the suppression of recurrent genital herpes simplex virus infection: a large-scale dose range-finding study. International Valaciclovir HSV Study Group. J Infect Dis 1998, 178:603–610.
Tyring SK, Douglas JM, Jr., Corey L, et al.: A randomized, placebo-controlled comparison of oral valacyclovir and acyclovir in immunocompetent patients with recurrent genital herpes infections. The Valaciclovir International Study Group. Arch Dermatol 1998, 134:185–191.
Pue MA, Benet LZ: Pharmacokinetics of famciclovir. Antiviral Chem Chemother 1993, 4(suppl):47–56.
Schacker T, Hu HL, Koelle DM, et al.: Famciclovir for the suppression of symptomatic and asymptomatic herpes simplex virus reactivation in HIV-infected persons: a double blind, placebo-controlled trial. Ann Intern Med 1998, 128:21–28.
Whitley RJ: Antiviral Therapy. In Infectious Diseases, edn 2. Edited by Gorbach SL, Bartlett JG, Blacklow NR. Philadelphia: WB Saunders; 1998:330–350.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Whitley, R.J. Herpes simplex virus in children. Curr Treat Options Neurol 4, 231–237 (2002). https://doi.org/10.1007/s11940-002-0040-2
Issue Date:
DOI: https://doi.org/10.1007/s11940-002-0040-2