. Author manuscript; available in PMC: 2013 Jun 19.

Published in final edited form as: Clin Pharmacol Ther. 2010 Sep 29;88(5):720–724. doi: 10.1038/clpt.2010.192

Table 1.

Treatment of pediatric HSV infections

Orolabial	First episode	Acyclovir 75 mg/kg/day p.o. ÷ 5 times/day (max 1 g/day) × 7 days, or 5 mg/kg/dose i.v. 3 times/day × 5–7 days
		Valacyclovir^a 1 g p.o. b.i.d. × 7 days, or 2 g p.o. b.i.d. × 1 day (if ≥12 y.o.)
		Famciclovir^a 500 mg p.o. b.i.d. × 7 days (≥18 y.o.)
	Recurrent	Acyclovir 400 mg p.o. 5 times/day × 5 days
		Valacyclovir^a 2 g p.o. b.i.d. × 1 day (≥12 y.o.)
		Famciclovir^a 1.5 g p.o. ×1 day (≥18 y.o.)
Anogenital	First episode	Acyclovir 40–80 mg/kg/day p.o. ÷ 3–4 times/day × 5–10 days (max 1 g/day), or 1–1.2 g/day p.o. ÷ 3–5 times/day (if ≥12 y.o.) × 5–10 days, or 5 mg/kg/dose i.v. 3 times/day × 5–7 days
		Valacyclovir^a 1 g p.o. b.i.d. 7–10 days (≥18 y.o.)
		Famciclovir^a 250 mg p.o. t.i.d. × 7–10 days (≥18 y.o.)³⁰
	Recurrent	Acyclovir 200 mg p.o. 5 times/day × 5 days (≥12 y.o.), or 400 mg p.o. t.i.d. × 5 days
		Valacyclovir^a 500 mg p.o. b.i.d. × 3–5 days; 1 g p.o. daily × 5 days; 1 g p.o. b.i.d. × 1 day (≥18 y.o.)
		Famciclovir^a 125 mg p.o. b.i.d. × 5 days, 500 mg p.o. b.i.d. × 5 days, or 1 g p.o. b.i.d. × 1 day (≥18 y.o.)
Neonatal	SEM	Acyclovir 60 mg/kg/day i.v. ÷ 3 times/day × 14 days
	CNS	Acyclovir 60 mg/kg/day i.v. ÷ 3 times/day × 21 days
	Disseminated	Acyclovir 60 mg/kg/day i.v. ÷ 3 times/day × 21 days
HSE	≤12 y.o.	Acyclovir 45–60 mg/kg/day i.v. ÷ 3 times/day × 14–21 days
HSE	>12 y.o.	Acyclovir 30 mg/kg/day i.v. ÷ 3 times/day × 14–21 days
Ocular	Epithelial	Topical trifluorothymidine, vidarabine, idoxuridine, or acyclovir; no topical steroids
Ocular	Stromal	Topical trifluorothymidine, vidarabine, idoxuridine, or acyclovir; topical steroids indicated, also consider systemic acyclovir
Immunocompromised patients (localized, visceral, or disseminated)	<12 y.o.	Acyclovir 30 mg/kg/day i.v. ÷ 3 times/day × 7–14 days³⁰
	≥12 y.o.	Acyclovir 15 mg/kg/day i.v. ÷ 3 times/day × 7–14 days³⁰
	≥2 y.o.	Acyclovir 1 g/day p.o. ÷ 3–5 times/day × 7–14 days³⁰
	Foscarnet^a	80–120 mg/kg/day ÷ 2–3 times/day³⁰
	Cidofovir^a	Induction: 5 mg/kg/dose i.v. once weekly × 2 weeks³⁰ Maintenance: 5 mg/kg/dose i.v. once every 2 weeks³⁰

b.i.d., twice daily; CNS, central nervous system; HSE, herpes simplex encephalitis; HSV, herpes simplex virus; i.v., intravenous; p.o., oral; SEM, skin, eye, or mouth; t.i.d., three times daily; y.o., years old.

Insufficient data to determine pediatric dosing.