To evaluate the use and benefit of oral antivirals in the acute treatment of episodic, recurrent herpes labialis.
DATA SOURCES
A literature search was performed in MEDLINE (1966—August 2003) using acyclovir, famciclovir, valacyclovir, cold sores, herpes labialis, and HSV-1 as search terms.
DATA SYNTHESIS
We reviewed 5 placebo-controlled and 2 comparative studies evaluating oral antivirals for acute treatment of recurrent herpes labialis. No studies directly compared different antivirals. Studies discussing the efficacy of antivirals for chronic suppression of herpes simplex virus-1 infection were not included.
CONCLUSIONS
Treatment with oral antivirals decreases the duration of lesion episodes and pain by approximately one day; however, the antivirals do not abort lesions from developing. Clinical implications of these results appear relatively modest.
. PolandJM. Current therapeutic management of recurrent herpes labialis. Gen Dentistry1994; 42: 46–50.
2.
. EmbilJA, StephensRG, ManuelFR. Prevalence of recurrent herpes labialis and aphthous ulcers among young adults on six continents. Can Med Assoc J1975; 113: 627–30.
3.
. RooneyJF, StrausSE, MannixML, WohlenbergCR, AllingDW, DumoisJA, Oral acyclovir to suppress frequently recurrent herpes labialis: a double-blind, placebo-controlled trial. Ann Intern Med1993; 118: 268–72.
4.
. SpruanceSL, HamillML, HogeWS, DavisLG, MillsJ. Acyclovir prevents reactivation of herpes simplex labialis in skiers. JAMA1988; 260: 1597–9.
5.
. HabifTP. Herpes simplex. In: BaxterS, ed. Clinical dermatology: a color guide to diagnosis and therapy. 3rd ed.St. Louis. Mosby-Year Book, 1996: 325–44.
6.
. CoreyL. Herpes simplex virus. In: MandellGL, BennettJE, DolinR, eds. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 5th ed.Philadelphia. Churchill Livingstone, 1998: 1564–80.
7.
. SpruanceSL, WenerstromG. Pathogenesis of recurrent herpes simplex labialis. I V. Maturation of lesions within 8 hours after onset and implication for antiviral treatment. Oral Surg1984; 58: 667–71.
8.
. BaderC, CrumpackerCS, SchnipperLE, RansilB, ClarkJE, ArndtK, The natural history of recurrent facial-oral infection with herpes simplex virus. J Infect Dis1978; 138: 897–905.
9.
. SpruanceSL, NettR, MarburyT, WolffR, JohnsonJ, SpauldingT. Acyclovir cream for treatment of herpes simplex labialis: results of two randomized, double-blind, vehicle-controlled, multicenter clinical trials. Antimicrob Agents Chemother2002; 46: 2238–43.
10.
. SpruanceSL, ReaTL, ThomingC, TuckerR, SaltzmanR, BoonR. Penciclovir cream for the treatment of herpes simplex labialis: a randomized, multicenter, double-blind, placebo-controlled trial. JAMA1997; 277: 1374–9.
11.
. RabornGW, McGawWT, GraceM, TyrrellLD, SamuelsSM. Oral acyclovir and herpes labialis: a randomized, double-blind, placebo-controlled study. J Am Dent Assoc1987; 115: 38–42.
. SpruanceSL, RoweNH, RabornGW, ThibodeauEA, D'AmbrosioJA, BernsteinDI. Perioral famciclovir in the treatment of experimental ultraviolet radiation-induced herpes simplex labialis: a double-blind, dose-ranging, placebo-controlled, multicenter trial. J Infect Dis1999; 179: 303–10.
14.
. SpruanceSL, JoneTM, BlatterMM, Vargas-CortesM, BarberJ, HillJ, High-dose, short-duration, early valacyclovir therapy for episodic treatment of cold sores: results of two randomized, placebo-controlled, multicenter studies. Antimicrob Agents Chemother2003; 47: 1072–80.
15.
. LaiskonisA, ThuneT, NeldamS, Hiltunen-BackE. Valacyclovir in the treatment of facial herpes simplex virus infection. J Infect Dis2002; 186 (suppl 1): S66–70.
16.
. ChosidowO, DrouaultY, GarraffoR, VeyssierP. Valacyclovir as a single dose during prodrome of herpes facialis: a pilot randomized double-blind clinical trial. Br J Dermatol2003; 148: 142–6.
17.
. Drug prices and information. www.drugstore.com (accessed 2004 Feb 4).
18.
. Package insert. Zovirax (acyclovir). Research Triangle Park, NC: Glaxo Smith Kline, August 2002.
. WellerS, BlumMR, DoucetteM, BurnetteT, CederbergDM, MirandaP, Pharmacokinetics of the acyclovir prodrug valaciclovir after escalating single and multiple-dose administration to normal volunteers. Clin Pharmacol Ther1993; 73: 110–6.
21.
. Package insert. Valtrex (valacyclovir). Research Triangle Park, NC: Glaxo Smith Kline, August 2002.
22.
. Soul-LawtonJ, SeaberE, OnN, WoottonR, RolanP, PosnerJ. Absolute bioavailability and metabolic disposition of valacyclovir, the l-valyl ester of acyclovir, following oral administration to humans. Antimicrob Agents Chemother1995; 39: 2759–64.
