Table 2.

Antiviral Drugs for the Treatment of Eczema Herpeticum Owing to HSV

Drug	Suggested adult/adolescent dose	Suggested pediatric dose	Comments
Acute treatment
Acyclovir	IV: 5-10 mg/kg/dose every 8 h Oral: 200-400 mg/dose 5 times daily	IV: 5-10 mg/kg/dose every 8 h ≥2 y: Oral 20 mg/kg/dose 4 times daily (max 800 mg/dose)	•Typical duration 7-14 d •Needs to be adjusted for abnormal renal function •Monitor renal function, electrolytes, and CBC while on therapy
Valacyclovir	Oral (typical): 1 g twice daily Oral (alternative): 500 mg 3 times daily	≥3 mo: Oral: 20 mg/kg/dose twice daily (max 1000 mg/dose)	•Off-label •Typical duration 5-7 d •Limited pediatric data •Compounded liquid form can be prepared with instructions on the drug package insert
Famciclovir	Oral: 500 mg/dose twice daily	Insufficient data to recommend dosing	•Off-label •Limited data •Typical duration 5-14 d •May be able to use higher doses for a shorter duration
Foscarnet	IV: 80-120 mg/kg/day in divided doses every 8-12 h	IV (limited data): 120 mg/kg/day in divided doses every 8-12 h	•Off-label, for acyclovir-resistant HSV infections •Continue until clinical response •Monitor renal function closely and ensure adequate hydration
Long-term suppressive therapy
Acyclovir	≥12 y: Oral: 400 mg/dose twice daily	Oral: 20 mg/kg/dose twice daily (max 400 mg/dose)	•Up to 12 mo duration •Limited data available •Monitor electrolytes, renal function, and CBC while on therapy
Valacyclovir	Oral: 1 g once daily	Insufficient data to recommend dosing	•Off-label •Limited data for nongenital infections

Abbreviations: CBC, complete blood cell count; HSV, herpes simplex virus; IV, intravenous.