Oral acyclovir also has a potential role in suppressing reactivations of HSV infections in immunocompromised patients or patients experiencing greater than 10-12 recurrences of genital herpes per year. Reduced doses have been successful for suppressive therapy. Acyclovir does not alter the frequency of recurrence once treatment has been discontinued. The relationship between plasma concentration and clinical response has not been established. Clinical studies have consistently reported minimal adverse effects with oral acyclovir.
Conservative use is justified by the potential development of resistant viral strains.
The extent and clinical importance of resistant viral selection remain to be determined. Oral acyclovir represents an advance in the development of a nontoxic antiviral agent suitable for both hospitalized and ambulatory patients that should be recommended for formulary inclusion. As most patients with first episode disease do not require hospitalization and recurrent disease is usually less severe than the primary infection, out-patient treatment forms the basis of practical management. Acyclovir is absorbed orally with plasma concentrations which exceed in vitro inhibitory concentrations for HSV1 and HSV2. No toxicity was observed.