6. Viral infections Flashcards
How is primary herpetic gingivostomatitis broadly managed?
Primary herpetic gingivostomatitis (as a result of herpes simplex virus (HSV)) is best managed by symptomatic relief. I.e.:
- nutritious diet
- plenty of fluids
- bed rest
- use of analgesics
- antimicrobial mouthwashes (either chlorhexidine or hydrogen peroxide). -> the use of antimicrobial mouthwashes controls plaque accumulation if toothbrushing is painful and also helps to control secondary infection in general.
What can be used to treat herpes simplex virus infections in immunocompromised patients and severe infections in non-immunocompromised patients?
Systemic antiviral agent, the drug of choice being aciclovir.
Give pts analgesics regularly to minimise oral discomfort; a topical benzydamine hydrochloride (oromucosal) spray might provide additional relief from oral discomfort and is particularly helpful in children.
Refer immunocomp pt with severe infection to hospital.
What is mild infection of the lips (herpes labialis (cold sores)) in non-immunocompromised pts be treated with?
Topical antiviral drug (aciclovir cream)
What condition is sometimes associated with herpes simplex virus?
Bell’s palsy.
Refer pts with Bell’s palsy to a specialist or the patient’s general medical practitioner for treatment.
What local measures should be used in herpes simplex virus infections?
- Advise the patient to avoid dehydration and alter their diet (to include soft food and adequate fluids) and use analgesics and antimicrobial mouthwash.
What is appropriate antimicrobial mouthwashes for herpes simplex infections? (2)
Chlorhexidine mouthwash 0.2% - rinse 1 minute with 10ml twice daily.
Hydrogen peroxide mouthwash, 6% - rinse 2 minutes with 15ml diluted in half a tumbler of warm water 3 times daily.
For infections in immunocompromised patients and severe infection in non-immunocomp pts, what can be prescribed for herpes simplex virus infections?
Acyclovir tablets, 200mg. 1 tablet 5x daily for 5 days. (total 25 tablets).
NB: in both adults and children, the dose can be doubled in immunocompromised pts or if absorption is impaired.
What can be used to treat herpes labialis in non-immunocomp patients?
Antiviral cream such as aciclovir.
Aciclovir cream 5%. Apply to lesions every 4 hours (5 times daily) for 5 days.
- can be applied for up to 10 days if required.
Administer this topical agent at the prodromal stage of a herpes labialis lesion to maximise its benefits.
What advise should be given to patients when prescribing chlorhexidine MW 0.2% for herpes simplex infections?
Advise patient to spit out mouthwash after rinsing and use until lesions have resolved and patient can carry out good oral hygiene.
Chlorhexidine gluconate might be incompatible with some ingredients in toothpaste; advise patient to leave an interval of at least 30 minutes between using mouthwash and toothpaste.
Also advise chlorhexidine mouthwash can be diluted 1:1 with water with no loss in efficacy.
What advise should be given when a pt is prescribed hydrogen peroxide mouthwash, 6%?
Advise pt to spit out mouthwash after rinsing and use until lesions have resolved and patient can carry out good oral hygiene.
Hydrogen peroxide mouthwash can be used as a rinse for up to 3 minutes if required.
How can you prescribe aciclovir tablets for herpes simplex virus infections in immunocomp pts and for severe infections in non-immunocomp pts?
Aciclovir tablets 200mg.
1 tablet, 5x/day for 5 days.
In both adults and children, the dose can be doubled in immunocomp pts or if absorption is impaired.
What is prescribed for herpes zoster (shingles) pts? why? (3)
Systemic antiviral agents reduce pain, and reduce the incidence of post-herpetic neuralgia and viral shedding.
Aciclovir is the drug of choice.
However, valaciclovir and famciclovir are suitable alternatives (although they can only be prescribed using a private prescription).
When (timeframe) should varicella-zoster infections be prescribed for? What else should you do in addition to a prescription?
Start treatment ideally at diagnosis or within 72 hours of the onset of the rash; even after this point antiviral treatment can reduce the severity of post-herpetic neuralgia.
In addition, refer all pts with herpes zoster to a specialist or their general medical practitioner.
What is an appropriate prescription to treat varicella-zoster infections (shingles)?
Acyclovir tablets, 800mg (shingles treatment pack).
Send: 35 tablets.
Label: 1 tablet 5 times daily for 7-days.
