Which drugs are most effective for recurrent herpes labialis?

Abstract

Evidence based answer: Daily oral acyclovir or valacyclovir may help prevent herpes simplex labialis (HSL) recurrences (strength of recommendation [SOR]: B, meta-analysis of randomized controlled trials [RCTs] with heterogeneous results). No trials compare oral or topical treatments for HSL outbreaks against each other. Oral antivirals modestly reduce healing time and duration of pain, varying according to the agent used: valacyclovir reduces both healing time and duration of pain, famciclovir reduces both in one dosage form but not another, and acyclovir reduces only pain duration (SOR: B, single RCTs). Several topical medications (acyclovir, penciclovir, docosanol) modestly decrease healing time and pain duration--typically by less than a day-- and require multiple doses per day (SOR: B, multiple RCTs).