What long-term treatment or prevention tips do you have for herpes labialis? Do you recommend low-dose suppressive antiviral therapy? What information do you have with regard to resistance rates among antivirals for herpes simplex virus?—SHAWN BROWN, FNP, Marshfield, Mo.
Randomized controlled trials evaluating chronic suppressive therapy for labial herpes have used the following dosing schedules: acyclovir 400 mg twice a day; and valacyclovir at either 500 mg once a day or 1 g once a day (the latter may be more effective in patients with a history of more frequent recurrences or immunosuppression). Valacyclovir 500 mg twice a day has also been used in HIV-positive patients. Randomized controlled trials of famciclovir specifically for chronic suppressive therapy of herpes labialis have not been conducted; however, long-term treatment may be effective in preventing the condition based on the observation that short courses of the drug in patients undergoing facial laser resurfacing (250 mg or 500 mg twice a day for 10 days starting one day prior to the procedure) prevented recurrence (Arch Intern Med. 2008;168:1137-1144). A recent review on antiviral resistance to acyclovir, valacyclovir, and famciclovir notes that cases of clinically relevant resistance to these drugs remains very rare in immunocompetent individuals ( J Clin Virol. 2009;26: 3-8).—Philip R. Cohen, MD (137-11)