Treatment of herpes simplex gingivostomatitis with aciclovir in children: A randomised double blind placebo controlled study

Objectives: To examine the efficacy of aciclovir suspension for treating herpetic gingivostomatitis in young children. Design: Randomised double blind placebo controlled study. Setting: Day care unit of a tertiary paediatric hospital. Subjects: 72 children aged 1-6 years with clinical manifestations of gingivostomatitis lasting less than 72 hours; 61 children with cultures positive for herpes simplex virus finished the study. Main outcome measures: Duration of oral lesions, fever, eating and drinking difficulties, and viral shedding. Intervention: Aciclovir suspension 15 mg/kg five times a day for seven days, or placebo. Results: Children receiving aciclovir had oral lesions for a shorter period than children receiving placebo (median 4 v 10 days (difference 6 days, 95% confidence interval 4.0 to 8.0)) and earlier disappearance of the following signs and symptoms: fever (1 v 3 days (2 days, 0.8 to 3.2)); extraoral lesions (lesions around the mouth but outside the oral cavity) (0 v 5.5 days (5.5 days, 1.3 to 4.7)); eating difficulties (4 v 7 days (3 days, 1.31 to 4.69)); and drinking difficulties (3 v 6 days (3 days, 1.1 to 4.9)). Viral shedding was significantly shorter in the group treated with aciclovir (1 v 5 days (4 days, 2.9 to 5.1)). Conclusions: Oral aciclovir treatment for herpetic gingivostomatitis, started within the first three days of onset, shortens the duration of all clinical manifestations and the infectivity of affected children. Further studies are needed to evaluate the ideal dose and length of treatment.