# Herpetic gingivostomatitis (primary oral herpes) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - 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) - Verified date: 2026-08 ## 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) ## Treatment metadata - Acyclovir — 200 mg — oral.liquid - Referral & safety-netting (no drug therapy) - Paracetamol — 120 mg — oral.liquid ## Complete treatment card ```text HERPETIC GINGIVOSTOMATITIS (PRIMARY ORAL HERPES) 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 against 5 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Primary infection may be silent, but most children develop fever, poor appetite, irritability, and painful mouth sores [fever · irritability · mouth ulcers · poor appetite] - Malaise, tiredness, and swollen neck or jaw glands often accompany the mouth lesions [fatigue · malaise] - Recurrences begin with burning and itching before blisters appear in a limited area [blisters · itching · relapse] - The lesions recur in the same spot with every episode - Physical or emotional stress, illness, sunlight, or trauma can trigger a recurrence [relapse] SIGNS - what you find (5) - The first sign is redness of the mouth and surrounding skin, followed by fast-spreading blisters on the gums, palate, and cheek and lip lining [blisters · redness] - Ulcers look flat and yellowish, roughly 2 to 5 mm across, bleed easily, and clear without a scar over two to three weeks - One in three patients who has a first episode goes on to have recurrent lesions - Recurrent lesions favour keratinised skin such as the lip border, skin around the mouth, or the hard palate - Recurrent episodes cause only mild malaise and gland swelling compared with the first infection [malaise] TESTS (5) - Diagnosis is usually clinical, based on the history and the appearance of the oral lesions alone - Direct immunofluorescence on ulcer scrapings or blister fluid can confirm the diagnosis when needed - A Tzanck smear confirms a herpesvirus is present but cannot tell HSV-1, HSV-2, and varicella- zoster apart - Viral culture isolation is the gold-standard confirmatory test - Antibody testing can show seroconversion but does not by itself make the diagnosis IF NOT THIS - what else fits (12) - Herpetic gingivostomatitis must be differentiated from herpes zoster - Herpetic gingivostomatitis must be differentiated from primary chickenpox - Herpetic gingivostomatitis must be differentiated from Behcet disease - Herpetic gingivostomatitis must be differentiated from herpetiform aphthae - Herpetic gingivostomatitis must be differentiated from erythema multiforme - Herpetic gingivostomatitis must be differentiated from acute necrotising gingivostomatitis - Herpetic gingivostomatitis must be differentiated from reactive arthritis - Herpetic gingivostomatitis must be differentiated from cytomegalovirus ulceration - Herpetic gingivostomatitis must be differentiated from traumatic ulcers - Herpetic gingivostomatitis must be differentiated from chemical or thermal burns - Herpetic gingivostomatitis must be differentiated from a factitial injury - Herpetic gingivostomatitis must be differentiated from vesiculobullous disease Source StatPearls "Herpetic Gingivostomatitis" - disease-level clinical article Status traced to the source above 1. ACYCLOVIR [1st line] Adult 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) x 7 to 10 days (adult); 7 days (child) Peds 15 mg/kg/dose [child max 200 mg] (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.) 1 to 6 years: 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. 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 200 mg/dose (capped) 15kg -> 200 mg/dose (capped) 16kg -> 200 mg/dose (capped) 17kg -> 200 mg/dose (capped) 18kg -> 200 mg/dose (capped) 19kg -> 200 mg/dose (capped) 20kg -> 200 mg/dose (capped) 21kg -> 200 mg/dose (capped) 22kg -> 200 mg/dose (capped) 23kg -> 200 mg/dose (capped) 24kg -> 200 mg/dose (capped) 25kg -> 200 mg/dose (capped) 26kg -> 200 mg/dose (capped) 27kg -> 200 mg/dose (capped) 28kg -> 200 mg/dose (capped) 29kg -> 200 mg/dose (capped) 30kg -> 200 mg/dose (capped) 31kg -> 200 mg/dose (capped) 32kg -> 200 mg/dose (capped) 33kg -> 200 mg/dose (capped) 34kg -> 200 mg/dose (capped) 35kg -> 200 mg/dose (capped) 36kg -> 200 mg/dose (capped) 37kg -> 200 mg/dose (capped) 38kg -> 200 mg/dose (capped) 39kg -> 200 mg/dose (capped) 40kg -> 200 mg/dose (capped) 41kg -> 200 mg/dose (capped) 42kg -> 200 mg/dose (capped) 43kg -> 200 mg/dose (capped) 44kg -> 200 mg/dose (capped) 45kg -> 200 mg/dose (capped) 46kg -> 200 mg/dose (capped) 47kg -> 200 mg/dose (capped) 48kg -> 200 mg/dose (capped) 49kg -> 200 mg/dose (capped) 50kg -> 200 mg/dose (capped) Source Egyptian National Drug Formulary - Antimicrobial 2023 (acyclovir monograph) Why 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. Caution 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. Egypt BORGAVIRAX 200MG/5ML SUSP. 125 ML BORG 61.00 EGP VIRUSTAT 200MG/5ML SUSP. 120 ML PHAROPHARMA 61.00 EGP VIRUSTAT 400MG/5ML SUSP. 100 ML PHAROPHARMA 75.00 EGP -> ? strength differs, ? different route - not oral liquid ZOVIRAX D.S 400MG/5ML SUSP.100ML GLAXO SMITHKLINE 96.00 EGP -> ? strength differs, ? different route - not oral liquid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Herpetic gingivostomatitis - disease-level clinical article (herpetic-gingivostomatitis- clinical.txt) Why Carries the admission criteria and the supportive-care measures the disease article states, which apply whether or not acyclovir is given. Caution 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. 3. PARACETAMOL [add-on - not a substitute] Adult 1 g 3 or 4 times daily (max. 4 g daily) - According to clinical response Peds 15 mg/kg/dose [child max 500 mg] (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).) Age restriction: minimum 1 month 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 - paracetamol (oral) Why 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. Caution 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. Egypt CETAMOL 120MG/5ML PEDIATRIC SYRUP 120 ML MEMPHIS 8.50 EGP PARAGESIC BABY 120MG/5ML 120ML SUSP. AMRIYA 36.00 EGP PARAMOL 120MG/5ML SYRUP 125ML MISR 36.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral liquid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral liquid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)