What is the role of topical antivirals in the treatment of herpes simplex virus (HSV) infections?

Updated: Mar 17, 2020
  • Author: Sean P McGregor, DO, PharmD; Chief Editor: William D James, MD  more...
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Acyclovir is available as a 5% ointment or cream and can be applied 5-6 times per day for either 4 or 7 days for the treatment of herpes labialis or genital herpes, respectively. The cream formulation should be avoided in cases of genital herpes. The benefit of topical acyclovir in the treatment of herpes simplex infections is modest at best. Despite statistically significant benefits in clinical trials, clinically significant results are not appreciable. In a study that compared acyclovir 5% cream with vehicle in the treatment of herpes labialis, a reduction in the duration of recurrence by one half day was noted in the acyclovir group. [63] A combination of 5% acyclovir and 1% hydrocortisone is available and can be applied topically 5 times per day at the earliest sign of cold sore recurrence. It has been shown to prevent progression in comparison to acyclovir and placebo. [64] Penciclovir is another topical antiviral available as a 1% cream that can be applied every 2 hours for herpes labialis. The clinical efficacy of topical penciclovir is similar to topical acyclovir. Docosanol 10% cream is available over the counter and can be applied 5 times a day for up to 10 days. In a study that compared docosanol with placebo, the average resolution time was approximately 4 days, or 18 hours shorter than placebo. [65] As stated, topical treatments for herpes simplex are much less effective than systemic antivirals. The CDC recommends avoidance of topical antivirals, owing to a lack of clinical benefit. [48]

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