Acyclovir for treating primary herpetic gingivostomatitis

Nasser M, Fedorowicz Z, Khoshnevisan MH, Shahiri Tabarestani M

Published Online:

October 8, 2008

There is some weak evidence that acyclovir can be an effective treatment in decreasing some of the symptoms caused by primary herpetic gingivostomatitis.
Primary herpetic gingivostomatitis is a highly contagious infection of the oral cavity which is caused by the herpes simplex virus. It is prevalent in children and young adolescents and sometimes can cause uncomfortable symptoms including eating and drinking difficulties and even life-threatening inflammation of the brain (encephalitis).
This review included two trials (92 participants) but only one of them provided some limited evidence to suggest that acyclovir is an effective treatment in reducing the number of oral lesions, preventing the development of new extraoral lesions, decreasing the number of individuals with difficulties experienced in eating and drinking and of those who are admitted to hospital for children under 6 years of age with primary herpetic gingivostomatitis.

Abstract (click to read)

Background:

Primary herpetic gingivostomatitis is a highly contagious infection of the oral cavity which typically affects children but can also occur in adults. Symptoms may vary widely from mild discomfort to life-threatening encephalitis.

Objectives:

The objective of this review was to evaluate the effectiveness of systemic acyclovir for primary herpetic gingivostomatitis.

Search strategy:

We searched the following databases: Cochrane Oral Health Group's Trials Register (to 22 May 2008); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 2); MEDLINE (1950 to 22 May 2008); and EMBASE (1980 to 22 May 2008). There were no language restrictions.

Selection criteria:

Randomised controlled trials comparing acyclovir to placebo in children and young adults < 25 years of age with a diagnosis of primary herpetic gingivostomatitis with or without herpes labialis were considered.

Data collection and analysis:

Two review authors independently and in duplicate screened and extracted information from, and assessed the risk of bias in the included clinical trials. The Cochrane Collaboration statistical guidelines were followed for data synthesis.

Main results:

Only two clinical trials, one with 72 participants and the other with 20 participants were included in this review. The second study failed to report several methodological items and was inconsistent in its reporting of the outcomes measurement.
The first trial, with a moderate risk of bias, showed better results in the acyclovir group compared to the placebo group in children < 6 years of age in reducing the number of individuals with oral lesions (risk ratio (RR) 0.10 (95% confidence interval (CI) 0.02 to 0.38)), new extraoral lesions (RR 0.04 (95% CI 0.00 to 0.65)), difficulty in eating (RR 0.14 (95% CI 0.03 to 0.58)), and drinking difficulties (RR 0.11 (95% CI 0.01 to 0.83)) after 8 days of treatment.
Following the onset of treatment, three patients from the placebo group were admitted to hospital for rehydration (P = 0.11).
Four children (two from the acyclovir, and two from the placebo group) showed mild gastrointestinal symptoms that resolved spontaneously after 24 to 48 hours without a change in the study treatment.

Authors' conclusions:

We found two relevant trials in this systematic review, only one of them could provide some weak evidence that acyclovir is an effective treatment in reducing the number of oral lesions, preventing the development of new extraoral lesions, decreasing the number of individuals with difficulties experienced in eating and drinking and reducing hospital admission for children under 6 years of age with primary herpetic gingivostomatitis.

This record should be cited as:

Nasser M, Fedorowicz Z, Khoshnevisan MH, Shahiri Tabarestani M. Acyclovir for treating primary herpetic gingivostomatitis. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD006700. DOI: 10.1002/14651858.CD006700.pub2

Assessed as up to date:

June 26, 2008

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Primary Review Group:

Oral Health Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

How effective is acyclovir for treating primary herpetic gingivostomatitis (PHG)?

Bottom line:

One trial (n=72) provided some limited evidence to suggest for children under 6 years of age with PHG acyclovir is effective in reducing the number of oral lesions (NNT* 2), preventing the development of new extraoral lesions (NNT 3), decreasing the difficulty experienced in eating (NNT 3) and drinking (NNT 5) and reducing admissions to hospital (NNT 12). * NNT = number needed to treat to benefit 1 individual.

Caveat:

Only 2 trials, one with 72 participants and the other with 20 participants, were included in this review. The second study failed to report several methodological items and was inconsistent in its reporting of the outcomes measured.

Context:

PHG is a highly contagious infection of the oral cavity which is caused by the herpes simplex virus. Only about 5-10% of patients initially infected with the virus develop clinical lesions. It is prevalent in children and adolescents and sometimes can cause uncomfortable symptoms including eating and drinking difficulties and, rarely, life threatening encephalitis.

Cochrane Systematic Review:

Nasser M et al. Acyclovir for treating primary herpetic gingivostomatitis. Cochrane Reviews 2008, Issue 4. Article No. CD006700. DOI: 10.1002/14651858.CD006700.pub2. This review contains 2 trials involving 92 participants.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Health topics:

Dentistry & oral health > Gingivostomatitis

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Acyclovir for treating primary herpetic gingivostomatitis

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