Which Drugs Are Most Effective for Recurrent Herpes Labialis?
Evidence-based answers from the clinical inquiries Family Physicians Inquiries Network Eiko Tubridy, MD; Gary Kelsberg, MD Valley Family Residency Which drugs are most Program, Renton, Wash Leilani St Anna, MLIS, effective for recurrent AHIP University of Washington Health Sciences Libraries, herpes labialis? Seattle AssistanT EDITOR EvidEncE-basEd answEr Jon O. neher, MD Valley Family Residency daily oral acyclovir or vala- ing to the agent used: valacyclovir reduces Program, Renton, Wash A cyclovir may help prevent her- both healing time and duration of pain, pes simplex labialis (HSL) recurrences famciclovir reduces both in one dosage (strength of recommendation [SOR]: B, form but not another, and acyclovir reduces meta-analysis of randomized controlled only pain duration (SOR: B, single RCTs). trials [RCTs] with heterogeneous results). Several topical medications (acyclovir, No trials compare oral or topical treat- penciclovir, docosanol) modestly decrease ments for HSL outbreaks against each oth- healing time and pain duration—typically er. Oral antivirals modestly reduce healing by less than a day—and require multiple time and duration of pain, varying accord- doses per day (SOR: B, multiple RCTs). Evidence summary The authors of the meta-analysis noted A systematic review and meta-analysis of the that although 9 studies favored the use of an effectiveness of oral and topical nucleoside antiviral drug, only 4 showed statistically sig- antiviral agents to prevent recurrent HSL in nificant differences when compared with pla- immunocompetent people found 11 RCTs cebo, and none of them had a low risk of bias. with a total of 1250 patients that compared They concluded that the review supported us- an active drug against placebo.1 The medi- ing oral acyclovir and valacyclovir to prevent cations were topical 5% acyclovir, topical 1% recurrent HSL.1 penciclovir, and oral acyclovir, valacyclovir, or famciclovir in various doses.
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