{ "schema_version": 1, "kind": "condition", "id": "herpetic-gingivostomatitis", "name": "Herpetic gingivostomatitis (primary oral herpes)", "category": "infectious", "sources": "Herpetic Gingivostomatitis - StatPearls (NCBI Bookshelf NBK526068) - https://www.ncbi.nlm.nih.gov/books/NBK526068/ · Egyptian National Drug Formulary - Antimicrobial 2023 (acyclovir monograph) · MSF Essential Drugs 2024 - paracetamol (oral) · Herpetic gingivostomatitis - disease-level clinical article (herpetic-gingivostomatitis-full.txt) · Herpetic gingivostomatitis - disease-level clinical article (herpetic-gingivostomatitis-clinical.txt)", "review_status": "reviewed", "verified_against": "Herpetic Gingivostomatitis - StatPearls (NCBI Bookshelf NBK526068) - https://www.ncbi.nlm.nih.gov/books/NBK526068/ · Egyptian National Drug Formulary - Antimicrobial 2023 (acyclovir monograph) · MSF Essential Drugs 2024 - paracetamol (oral) · Herpetic gingivostomatitis - disease-level clinical article (herpetic-gingivostomatitis-full.txt) · Herpetic gingivostomatitis - disease-level clinical article (herpetic-gingivostomatitis-clinical.txt)", "verified_date": "2026-08", "treatments": [ { "id": 935, "generic": "Acyclovir", "line": 1, "is_adjunct": false, "form": "oral.liquid", "strength_mg": 200.0, "adult_dose": "400 mg 3 times daily or 200 mg 5 times daily for 7 to 10 days (the formulary's adult mucocutaneous HSV regimen; this condition is overwhelmingly a disease of young children)", "adult_duration": "7 to 10 days (adult); 7 days (child)", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (acyclovir monograph)", "rationale": "Indication claim, disease article: a child with a working immune system who is in significant pain, or refusing to drink, can be given oral acyclovir provided they are seen inside the first 72 hours from the onset of the illness. Dose claim, Egyptian formulary, acyclovir monograph, under its HSV Gingivostomatitis / Oral heading: for immunocompetent children, 15 mg/kg to a ceiling of 200 mg, given 5 times daily for 7 days - a regimen it records as having been used in a small number of children aged 1 to 6. The formulary states the dose under this exact indication heading, so the indication and the dose come from named documents, not inference.", "cautions": [ "TIME WINDOW - the disease article reserves acyclovir for a child seen inside the first 72 hours from when the illness began. Beyond 72 hours the card is supportive care, not antiviral.", "Most children need no antiviral at all: herpetic gingivostomatitis is usually mild, settles on its own, and supportive care is generally enough.", "Prescribing limit, Egyptian formulary: by mouth, no more than 20 mg/kg given 4 times a day, to a ceiling of 1 g daily, in a child of 2 years or over weighing 40 kg or less.", "Contra-indication, Egyptian formulary: hypersensitivity to acyclovir, to valacyclovir, or to anything else in the preparation.", "Egyptian formulary monitoring: on high-dose therapy, watch a child for toxicity to the nervous system and to the kidneys. Keep the child drinking.", "Acyclovir CREAM is not a substitute here. The Egyptian formulary licenses the cream for one thing only - recurrent cold sores (herpes labialis) in immunocompetent children of 12 years and over, in adolescents and in adults - and not for primary gingivostomatitis, nor for the age group that gets it." ], "peds_mgkg_low": 15.0, "peds_mgkg_high": 15.0, "peds_max_mg": 200.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "Immunocompetent children: 15 mg/kg (up to 200 mg) 5 times daily for 7 days has been used in a few children 1–6 years of age. Note the frequency: FIVE times a day, not three. The formulary's separate HIV-infected schedule is 20 mg/kg (up to 400 mg) 3 times daily for 7–14 days.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "1 to 6 years", "age_min_months": 12, "age_max_months": 83, "dose_text": "Immunocompetent: 15 mg/kg (up to 200 mg) FIVE times daily for 7 days. The HIV-infected schedule is different: 20 mg/kg (up to 400 mg) 3 times daily." } ], "peds_doses": [ { "weight_kg": 10, "low_mg": 150, "high_mg": 150, "capped": false }, { "weight_kg": 20, "low_mg": 200, "high_mg": 200, "capped": true }, { "weight_kg": 30, "low_mg": 200, "high_mg": 200, "capped": true }, { "weight_kg": 40, "low_mg": 200, "high_mg": 200, "capped": true } ], "brands": [ { "trade_name": "BORGAVIRAX 200MG/5ML SUSP. 125 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "BORG", "price_egp": 61.0, "pack_count": null, "unit_price": null, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VIRUSTAT 200MG/5ML SUSP. 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 61.0, "pack_count": null, "unit_price": null, "strength_mg": 200.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VIRUSTAT 400MG/5ML SUSP. 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 75.0, "pack_count": null, "unit_price": null, "strength_mg": 400.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "ZOVIRAX D.S 400MG/5ML SUSP.100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE", "price_egp": 96.0, "pack_count": null, "unit_price": null, "strength_mg": 400.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "herpetic-gingivostomatitis" }, { "id": 937, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": null, "adult_duration": null, "dose_source": "Herpetic gingivostomatitis - disease-level clinical article (herpetic-gingivostomatitis-clinical.txt)", "rationale": "Carries the admission criteria and the supportive-care measures the disease article states, which apply whether or not acyclovir is given.", "cautions": [ "RED FLAG - a child who cannot drink enough to stay hydrated is admitted. Dehydration, not the virus, is what admits these children.", "RED FLAG - the other stated reasons to admit: a child who is immunocompromised, one who develops eczema herpeticum, and HSV that has spread to cause encephalitis or pneumonitis.", "Supportive care: a barrier cream on the lips, petroleum jelly for instance, has been suggested to keep the surfaces from sticking together while the gingivostomatitis is active. (Herpetic Gingivostomatitis - StatPearls - NCBI Bookshelf, NBK526068)", "Safety-netting: manage the child at home, but watch closely for anything developing - trouble eating or drinking, or lesions that are getting worse. (Herpetic Gingivostomatitis - StatPearls - NCBI Bookshelf, NBK526068)", "Counsel the family that recurrence is expected: of the children who go through a primary herpetic gingivostomatitis, one in three will go on to get the oral lesions again as cold sores, or herpes labialis." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": null, "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "herpetic-gingivostomatitis" }, { "id": 936, "generic": "Paracetamol", "line": 1, "is_adjunct": true, "form": "oral.liquid", "strength_mg": 120.0, "adult_dose": "1 g 3 or 4 times daily (max. 4 g daily)", "adult_duration": "According to clinical response", "dose_source": "MSF Essential Drugs 2024 - paracetamol (oral)", "rationale": "Indication claim, disease article: hydration matters more than anything else in this illness, and controlling the pain is usually what makes it possible - so an analgesic by mouth, paracetamol among them, together with mouth rinses, is encouraged to settle the child enough to drink. Dose claim, MSF Essential Drugs 2024 paracetamol (oral), under its mild-pain and fever indications: a child of 1 month and over takes 15 mg/kg given 3 or 4 times a day, to a ceiling of 60 mg/kg daily. Analgesia here is not comfort alone - it is what keeps the child drinking.", "cautions": [ "MSF: never go above the stated dose, and least of all in a child or an older patient. Paracetamol poisoning is severe, and what it destroys is the liver cells.", "MSF: give it cautiously where the liver is impaired.", "The dose comes down in a child with severe acute malnutrition: 10 mg/kg, and no more than 3 times in 24 hours.", "Give the dose BEFORE offering fluids or food, so the child can actually swallow." ], "peds_mgkg_low": 15.0, "peds_mgkg_high": 15.0, "peds_max_mg": 500.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "Child 1 month and over: 15 mg/kg 3 or 4 times daily (max. 60 mg/kg daily). Child under 1 month: 10 mg/kg 3 or 4 times daily (max. 40 mg/kg daily).", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": 1.0, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 150, "high_mg": 150, "capped": false }, { "weight_kg": 20, "low_mg": 300, "high_mg": 300, "capped": false }, { "weight_kg": 30, "low_mg": 450, "high_mg": 450, "capped": false }, { "weight_kg": 40, "low_mg": 500, "high_mg": 500, "capped": true } ], "brands": [ { "trade_name": "CETAMOL 120MG/5ML PEDIATRIC SYRUP 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 8.5, "pack_count": null, "unit_price": null, "strength_mg": 120.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARAGESIC BABY 120MG/5ML 120ML SUSP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMRIYA", "price_egp": 36.0, "pack_count": null, "unit_price": null, "strength_mg": 120.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARAMOL 120MG/5ML SYRUP 125ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 36.0, "pack_count": null, "unit_price": null, "strength_mg": 120.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FEBRIMOL ORAL DROPS 20 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 4.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "THERA-LO 3.2G/100ML ORAL SUSP. 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 3200.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "herpetic-gingivostomatitis" } ] }