Review
Current management and recommendations for access to antiviral therapy of herpes labialis

https://doi.org/10.1016/j.jcv.2011.08.003Get rights and content

Abstract

Herpes labialis is a common skin infective condition, worldwide, which is primarily caused by HSV-1. Recurrent episodes of herpes labialis, also known as cold sores, can be frequent, painful, long-lasting and disfiguring for infected patients. At present, there are two types of antivirals for the treatment of herpes labialis, topical and oral, which are available over the counter or as prescription-only. The aim of antiviral therapy is to block viral replication to enable shortening the duration of symptoms and to accelerate healing of the lesions associated with herpes labialis. This review examines the evidence for the effectiveness of current topical and oral antivirals in the management of recurrent episodes of herpes labialis. In most countries, oral antivirals for herpes labialis are available as prescription-only. However, in early 2010, the oral antiviral famciclovir was reclassified from prescription-only medicine to pharmacist-controlled status in New Zealand. The benefits and risks associated with moving an antiviral therapy for herpes labialis from prescription-only to pharmacist-controlled status are reviewed here, and the implications for patients, general physicians and pharmacists are considered.

Section snippets

Current diagnosis and management of herpes labialis

Diagnosis of herpes labialis by GPs is usually based on the patient history of this condition, the clinical signs and symptoms. Laboratory confirmation, however, may be required in immunocompromised patients if the clinical presentation is atypical.

Many patients neither require nor use any treatment because the disease is self-limiting.20 For individuals with frequent recurrences, application of a sunscreen or zinc oxide to decrease the probability of recurrent outbreaks may help. 21, 22 Some

Risks versus benefits of reclassification of antiviral therapy

Despite the recent publication of an evidence-based review suggesting that oral antiviral agents are more beneficial than topical agents for treating recurrent episodes,21 antiviral tablets are currently only available by prescription (POM or Rx only) in most countries. Availability would be facilitated by a product being reclassified as a pharmacy-only (pharmacist-controlled) medicine. This is defined as a product that can be obtained without a prescription provided that a pharmacist is

Pharmaco-economic benefits of OTC therapies

Generally, OTC therapies are more accessible and convenient than prescription medications and are usually cheaper because they are often generic.60 In some countries, patients may have to pay the full cost of a POM but, in others, patients may only have to pay a fixed prescription charge that could be the same or less than the OTC price. The change from POM to OTC status of medications has been the direction followed by more than 700 treatments over the past 30 years and has led to annual

Conclusions

Initial diagnosis of herpes labialis should be made by GPs. With patient education, thereafter, a significant reduction in a GP's work burden, as well as cost-savings for both the patient and the GP, could result from the availability of pharmacy-controlled antiviral medication for herpes labialis. Another important consideration is reducing the delay in the start of treatment, with patients being able to self-medicate as soon as they feel the prodrome of a herpes labialis outbreak. Suitable

Funding

‘The availability of OTC oral antivirals for cold sores’ Advisory Board Meeting, held 16–17 April 2009, in Annecy, France, was sponsored by an educational grant from Novartis.

Competing interests

AC has participated in roundtable discussions on antivirals for herpesviruses sponsored by Novartis, GlaxoSmithKline and 3M, and in clinical trials of antivirals sponsored by Novartis and GlaxoSmithKline. LS is a consultant in vaccine development for GlaxoSmithKline and Sanofi-Pasteur; and has also received funding from the National Institutes of Health. RP has participated in advisory board meetings and speaker panels for Astellas, Becton Dickenson, GlaxoSmithKline and Novartis; and also

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