Mucocutaneous, Ocular, and Systemic Herpes Simplex Virus (HSV) Infections
Treatment of initial and recurrent mucocutaneous HSV-1 and HSV-2 infections (e.g., orofacial, esophageal, genital, nasal, labial) in immunocompromised adults, adolescents, and children, including HIV-infected individuals. Drug of choice.
Chronic suppressive or maintenance therapy (secondary prophylaxis) of recurrent HSV infections† in immunocompromised adults, adolescents, and children, including HIV-infected individuals who have frequent or severe recurrences.
Treatment of orolabial HSV infections (including gingivostomatitis) in immunocompetent† adults and children; generally ineffective or minimally effective for prevention of recurrence of herpes labialis† in immunocompetent individuals.
Treatment of HSV keratitis† in HIV-infected patients.
Prophylaxis against recurrence of ocular HSV disease† in immunocompetent adults and children ≥12 years of age who had ocular HSV disease (blepharitis, conjunctivitis, epithelial keratitis, stromal keratitis, iritis) in one or both eyes within the preceding 12 months. Has been used for prophylaxis after penetrating keratoplasty for herpetic keratitis.
Drug of choice for treatment of neonatal HSV infections, including mucocutaneous infections, infections involving skin, eyes, and mouth, and disseminated or CNS infections.
Drug of choice for prevention of HSV recurrence† in hematopoietic stem cell transplant (HSCT) recipients seropositive for HSV; such prophylaxis not indicated in those seronegative for HSV.
Genital Herpes
Treatment of initial episodes of genital herpes in adults and adolescents, including HIV-infected individuals.
Treatment of first episodes of herpes proctitis†.
Episodic treatment of recurrent episodes of genital herpes in adults and adolescents, including HIV-infected individuals.
Chronic suppressive therapy of recurrent episodes of genital herpes in adults and adolescents, including HIV-infected individuals.
CDC and others recommend oral acyclovir, oral famciclovir, or oral valacyclovir as drugs of choice for treatment of initial episodes of genital herpes and for episodic treatment or chronic suppressive therapy of recurrent genital herpes.
Varicella-Zoster Infections
Treatment of varicella (chickenpox) in immunocompromised adults, adolescents, and children, including HIV-infected individuals. Drug of choice.
Treatment of varicella (chickenpox) in immunocompetent adults, adolescents, and children. Varicella usually is a self-limited disease in otherwise healthy individuals and the role of acyclovir for treatment in these individuals is controversial; routine use not recommended by AAP and other clinicians.
Treatment of herpes zoster (shingles, zoster) in immunocompetent or immunocompromised adults, adolescents, and children, including HIV-infected individuals. Drug of choice for serious or disseminated herpes zoster in immunocompromised patients.
Treatment of herpes zoster ophthalmicus† in HIV-infected patients.
Treatment of dermatomal herpes zoster in immunocompromised patients† including transplant recipients and HIV-infected patients.
Alternative to varicella-zoster immune globulin (VZIG) for postexposure prophylaxis of VZV infection† in HSCT recipients. Although long-term prophylaxis not routinely recommended for prevention of recurrent VZV infections in HSCT recipients, such prophylaxis may be considered in those with severe, long-term immunodeficiency.
Prevention of Cytomegalovirus (CMV) Disease in Transplant Recipients
Has been used for prevention of CMV disease† in solid organ transplant recipients and bone marrow transplant (BMT) recipients at risk for the disease; data regarding efficacy are conflicting.
Has been used for prevention of CMV disease† in HSCT recipients; generally ineffective after autologous HSCT. Ganciclovir is drug of choice for prevention of CMV following autologous or allogeneic HSCT in adults, adolescents, and children.
Not effective for prevention of CMV disease in HIV-infected individuals.
Epstein-Barr Virus Infections and Disorders
Treatment of uncomplicated or complicated infectious mononucleosis, chronic infectious mononucleosis, and various disorders (e.g., oral hairy leukoplakia) associated with Epstein-Barr virus infections†; efficacy appears to be variable.
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