viral infections

Question 1

herpes simplex infections - how is PHG best managed?

Answer 1

symptomatic relief

• nutritious diet
• plenty of fluids
• bed rest
• analgesics
• antimicrobial MWs - controls plaque accumulation if toothbrushing painful and also helps to control secondary infection in general

Question 2

herpes simplex infections - when should systemic antiviral agent be used and what?

Answer 2

infections in immunocompromised pts and severe infections in non-immunocompromised pts
aciclovir

Question 3

herpes simplex infections - what topical agent can be used for relief?

Answer 3

topical benzydamine hydrochloride (oromucosal) spray for oral discomfort
esp helpful in children

Question 4

herpes simplex infections - when should you refer to hospital?

Answer 4

immunocompromised pts (adults and children) with severe infection

Question 5

herpes simplex infections - treatment of herpes labialis in non-immunocompromised pts

Answer 5

aciclovir cream

Question 6

herpes simplex infections - bells palsy

Answer 6

sometimes associated with herpes simplex - refer to specialist/GP for tx

Question 7

herpes simplex infections - local measures

Answer 7

first instance
advise pt to avoid dehydration and alter their diet (to include soft food and adequate fluids) and use analgesics and an antimicrobial MW

Question 8

herpes simplex infections - CHX MW

Answer 8

0.2%
send 300ml
rinse mouth for 1min with 10ml twice daily
same for children
advise pt to spit out MW after rinsing and use until lesions have resolved and pt can carry out good OH
chlorhexidine gluconate might be incompatible with some ingredients in toothpaste, advise pt to leave at least 30mins between using MW and toothpaste
advise pt CHX MW can be diluted 1:1 with water with no loss in efficacy

Question 9

herpes simplex infections - what MWs can be used?

Answer 9

CHX 0.2%

hydrogen peroxide 6%

Question 10

herpes simplex infections - hydrogen peroxide MW

Answer 10

6%
send 300ml
rinse mouth for 2mins with 15ml diluted in half a tumbler of warm water x3 daily
same for children
advise pt to spit out MW after rinsing and use until lesions have resolved and pt can carry out good OH
can be used as a rinse for up to 3mins if required

Question 11

herpes simplex infections - drug tx for IC pts and severe infections in non-IC pts

Answer 11

Aciclovir tablets 200mg
25 tablets
x5 daily
can double dose for adults and children in IC pts or if absorption impaired
same for 2-17 year olds (half dose for 6m-1yr)
can get oral suspension (SF available) 200mg/5ml

Question 12

herpes simplex infections - tx of herpes labialis in non-IC pts

Answer 12

administer at prodromal stage of a herpes labialis lesion to maximise its benefit
Aciclovir cream 5%
2g
apply to lesion every 4 hours (x5 daily) for 5 days
- can be applied for up to 10 days if required
same for children

Question 13

varicella-zoster infections - tx for herpes zoster (shingles)

Answer 13

systemic antiviral agents reduce pain and reduce incidence of post-herpetic neuralgia and viral shedding
Aciclovir drug of choice
- valaciclovir and famciclovir suitable alternatives (only on private prescription)
start tx ideally at diagnosis or within 72hrs of the onset of the rash; even after this point antiviral tx can reduce the severity of post-herpetic neuralgia
also refer all pts with herpes zoster to specialist/GP

Question 14

varicella-zoster infections - tx for herpes zoster (shingles) - Aciclovir dosage

Answer 14

Aciclovir tablets 800mg (shingles tx pack)
35 tablets
x5 daily
not licensed to tx herpes zoster in children