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. Author manuscript; available in PMC: 2011 May 27.
Published in final edited form as: Biol Blood Marrow Transplant. 2009 Oct;15(10):1143–1238. doi: 10.1016/j.bbmt.2009.06.019

Pathogen: Herpes simplex virus

Indication First Choice Alternatives
Prevention of early reactivation among seropositive HCT recipients (regardless of donor HSV serostatus)
Note: Start prophylaxis at the beginning of conditioning therapy and continue until engraftment or until mucositis resolves		 Acyclovir
Adults/Adolescents (≥40 kg):

  • 400–800 mg orally twice daily; or

  • 250 mg/m2/dose i.v. every 12 hours (AI);

Pediatrics (<40 kg):

  • 250 mg/m2/dose i.v. every 8 hours (BIII); or

  • 125 mg/m2/dose i.v. every 6 hours

  • Maximum dose, 80 mg/kg/day

 Adults/Adolescents (≥40 kg):
Valacyclovir, 500 mg orally daily (CIII); or 500 mg orally twice daily in highly immune suppressed patients (eg, T cell depletion, anti-T cell antibodies, high-dose steroids) (BIII)
Pediatrics (<40 kg): Acyclovir 60 – 90 mg/kg/ 24 hours orally, divided in 2–3 doses/day; or Valacyclovir 250 mg orally twice daily
Prevention of late reactivation among seropositive HCT recipients Acyclovir
Adults/Adolescents (≥40 kg): 800 mg orally twice daily during the first year after HCT (BIII)*
Pediatrics (<40 kg): 60–90 mg/kg orally divided in 2–3 doses daily (not to exceed 800 mg twice daily)		 Valacyclovir, oral dosing throughout the first year after HCT (BIII)
Adults: 500 mg twice daily
Pediatrics: 250 mg twice daily

HCT indicates hematopoietic cell transplantation; HSV, herpes simplex virus.

Note: For patients requiring prophylaxis for cytomegalovirus and herpes simplex virus after engraftment, ganciclovir alone provides effective prophylaxis for both pathogens.

*

For long-term prophylaxis, the higher dose of acyclovir is recommended for maximal viral suppression and minimization of resistance.