Indications And Dose
Herpes simplex, suppression ▶BY MOUTH ▶Child 12–17 years: 400 mg twice daily, alternatively 200 mg 4 times a day; increased to 400 mg 3 times a day, dose may be increased if recurrences occur on standard suppressive therapy or for suppression of genital herpes during late pregnancy (from 36 weeks gestation), therapy interrupted every 6–12 months to reassess recurrence frequency—consider restarting after two or more recurrences ▶Adult: 400 mg twice daily, alternatively 200 mg 4 times a day; increased to 400 mg 3 times a day, dose may be increased if recurrences occur on standard suppressive therapy or for suppression of genital herpes during late pregnancy (from 36 weeks gestation), therapy interrupted every 6–12 months to reassess recurrence frequency—consider restarting after two or more recurrences Herpes simplex, prophylaxis in the immunocompromised ▶BY MOUTH ▶Child 1–23 months: 100–200 mg 4 times a day ▶Child 2–17 years: 200–400 mg 4 times a day ▶Adult: 200–400 mg 4 times a day ▶BY INTRAVENOUS INFUSION ▶Adult: 5 mg/kg every 8 hours Herpes simplex, treatment (non-genital) ▶BY MOUTH ▶Adult: 200 mg 5 times a day usually for 5 days (longer if new lesions appear during treatment or if healing incomplete) Herpes simplex, treatment (non-genital) in immunocompromised or if absorption impaired ▶BY MOUTH ▶Adult: 400 mg 5 times a day usually for 5 days (longer if new lesions appear during treatment or if healing incomplete) Herpes simplex, treatment ▶BY MOUTH ▶Child 1–23 months: 100 mg 5 times a day usually for 5 days (longer if new lesions appear during treatment or if healing incomplete) ▶Child 2–17 years: 200 mg 5 times a day usually for 5 days (longer if new lesions appear during treatment or if healing incomplete) Herpes simplex, treatment, in immunocompromised or if absorption impaired ▶BY MOUTH ▶Child 1–23 months: 200 mg 5 times a day usually for 5 days (longer if new lesions appear during treatment or if healing incomplete) ▶Child 2–17 years: 400 mg 5 times a day usually for 5 days (longer if new lesions appear during treatment or if healing incomplete) Genital herpes simplex, treatment of first episode ▶BY MOUTH ▶Adult: 200 mg 5 times a day, alternatively 400 mg 3 times a day both courses usually for 5 days (longer if new lesions appear during treatment or if healing incomplete) Genital herpes simplex, treatment of first episode, in immunocompromised or HIV-positive ▶BY MOUTH ▶Adult: 400 mg 5 times a day for 7–10 days (longer if new lesions appear during treatment or if healing incomplete) Severe genital herpes simplex, treatment, initial infection | Treatment of herpes simplex in the immunocompromised ▶BY INTRAVENOUS INFUSION ▶Adult: Initially 5 mg/kg every 8 hours usually for 5 days, alternatively 10 mg/kg every 8 hours for at least 14 days in encephalitis (at least 21 days if also immunocompromised)—confirm cerebrospinal fluid negative for herpes simplex virus before stopping treatment, higher dose to be used only if resistant organisms suspected or in simplex encephalitis Genital herpes simplex, treatment of recurrent infection ▶BY MOUTH ▶Adult: 800 mg 3 times a day for 2 days, alternatively 200 mg 5 times a day for 5 days, alternatively 400 mg 3 times a day for 3–5 days Genital herpes simplex, treatment of recurrent infection in immunocompromised or HIV-positive patients ▶BY MOUTH ▶Adult: 400 mg 3 times a day for 5–10 days Varicella zoster (chickenpox), treatment | Herpes zoster (shingles), treatment ▶BY MOUTH ▶Child 1–23 months: 200 mg 4 times a day for 5 days ▶Child 2–5 years: 400 mg 4 times a day for 5 days ▶Child 6–11 years: 800 mg 4 times a day for 5 days ▶Child 12–17 years: 800 mg 5 times a day for 7 days ▶Adult: 800 mg 5 times a day for 7 days ▶BY INTRAVENOUS INFUSION ▶Adult: 5 mg/kg every 8 hours usually for 5 days Varicella zoster (chickenpox), treatment in immunocompromised | Herpes zoster (shingles), treatment in immunocompromised ▶BY INTRAVENOUS INFUSION ▶Adult: 10 mg/kg every 8 hours usually for 5 days Herpes zoster (shingles), treatment in immunocompromised ▶BY MOUTH ▶Child 1–23 months: 200 mg 4 times a day continued for 2 days after crusting of lesions ▶Child 2–5 years: 400 mg 4 times a day continued for 2 days after crusting of lesions ▶Child 6–11 years: 800 mg 4 times a day continued for 2 days after crusting of lesions ▶Child 12–17 years: 800 mg 5 times a day continued for 2 days after crusting of lesions ▶Adult: 800 mg 5 times a day continued for 2 days after crusting of lesions Herpes zoster, treatment in encephalitis | Varicella zoster, treatment in encephalitis ▶BY INTRAVENOUS INFUSION ▶Adult: 10 mg/kg every 8 hours given for 10–14 days in encephalitis, possibly longer if also immunocompromised or if severe infection Varicella zoster (chickenpox), attenuation of infection if varicella–zoster immunoglobulin not indicated ▶BY MOUTH ▶Child: 10 mg/kg 4 times a day for 7 days, to be started 1 week after exposure ▶Adult: 10 mg/kg 4 times a day for 7 days, to be started 1 week after exposure DOSES AT EXTREMES OF BODY-WEIGHT ▶With intravenous use To avoid excessive dosage in obese patients parenteral dose should be calculated on the basis of ideal weight for height. l UNLICENSED USE ▶With oral use in children Tablets and suspension not licensed for suppression of herpes simplex or for treatment of herpes zoster in children (age range not specified by manufacturer). ▶With oral use Aciclovir doses in BNF may differ from those in product literature. Attenuation of chickenpox is an unlicensed indication.
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