In cases of recurrent disease, virus shedding may be too brief to be detected by virus culture. Acyclovir is the treatment of choice for most cases of serious herpes infection and for prophylaxis. Acyclovir interferes with viral DNA polymerase. Parenteral acyclovir is indicated for severe or potentially severe infections, such as neonatal herpes infection, herpes encephalitis, and non-localized infections in immunocompromised patients. Oral acyclovir decreases new lesion formation and improves symptoms in first episode genital herpes.
Oral acyclovir has limited effect on the resolution of recurrent herpes disease.
Topical acyclovir is not effective for skin or oral lesions. The ophthalmic solution is useful for herpes keratitis, in combination with IV acyclovir. The most common adverse effect is gastrointestinal upset. 1000 mg orally twice a day for 5 days.