Route/Dosage
Initial Genital Herpes
• PO (Adults and Children): 200 mg q 4 hr while awake (5 times/day) for 7–10 days or 400 mg q 8 hr for 7–10 days; maximum dose in children: 80 mg/kg/day in 3–5 divided doses.
• IV (Adults and Children): 5 mg/kg q 8 hr or 750 mg/m2/day divided q 8 hr for 5–7 days.
Chronic Suppressive Therapy for Recurrent Genital Herpes• PO (Adults and Children): 400 mg twice daily or 200 mg 3–5 times/day for up to 12 mo. Maximum dose in children: 80 mg/kg/day in 2–5 divided doses.
Intermittent Therapy for Recurrent Genital Herpes• PO (Adults and Children): 200 mg q 4 hr while awake (5 times/day) or 400 mg q 8hr or 800 mg q 12 hr for 5 days, start at first sign of symptoms. Maximum dose in children: 80 mg/kg/day in 2–5 divided doses.
Acute Treatment of Herpes Zoster in Immunosuppressed Patients• PO (Adults): 800 mg q 4 hr while awake (5 times/day) for 7–10 days.
Prophylaxis—400 mg 5 times/day.
• PO (Children): 250–600 mg/m2/dose 4–5 times/day.
Herpes Zoster in Immunocompetent Patients• PO (Adults and Children): 4000 mg/day in 5 divided doses for 5–7 days, maximum dose in children: 80 mg/kg/day in 5 divided doses.
Chickenpox• PO (Adults and Children): 20 mg/kg (not to exceed 800 mg/dose) qid for 5 days. Start within 24 hr of rash onset.
Mucosal and Cutaneous Herpes Simplex Infections in Immunosuppressed Patients• IV (Adults and Children >12 yr): 5 mg/kg q 8 hr for 7 days.
• IV (Children <12 yr): 10 mg/kg q 8 hr for 7 days.
• Topical (Adults): 0.5 in. ribbon of 5%
ointment for every 4-square-in. area q 3 hr (6 times/day) for 7 days.
Herpes Simplex Encephalitis• IV (Adults): 10 mg/kg q 8 hr for 14–21 days.
• IV (Children 3 mo–12 yr): 10 mg/kg q 8 hr for 14–21 days.
• IV (Children birth–3 mo): 20 mg/kg q 8 hr for 14–21 days.
• IV (Neonates, premature): 10 mg/kg q 12 hr for 14–21 days.
Varicella Zoster Infections in Immunosuppressed Patients• IV (Adults): 10 mg/kg q 8 hr for 7–10 days.
• IV (Children <12 yr): 10 mg/kg q 8 hr for 7–10 days.
Renal Impairment• PO, IV (Adults and Children):
CCr >50 ml/min/1.73 m²—no dosage adjustment needed;
CCr 25 –50 ml/min/1.73 m²— administer normal dose q 12 hr;
CCr 10–25 ml/min/1.73 m²— administer normal dose q 24 hr;
CCr 0–10 ml/min/1.73 m²—50% of dose q 24 hr.
• IV (Neonates):
SCr 0.8–1.1 mg/dl:Administer 20 mg/kg/dose q 12 hr;
SCr 1.2–1.5 mg/dl:Administer 20 mg/kg/dose q 24 hr;
SCr >1.5 mg/dl:Administer 10 mg/kg/dose q 24 hr.
Herpes labialis• Topical (Adults and Children >12 yr): Apply 5 times/day for 4 days; start at first symptoms.
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