When herpes simplex esophagitis is complicated by severe odynophagia, outpatient oral management is typically insufficient. This scenario requires a more intensive, inpatient approach aimed at achieving rapid symptom relief.
This protocol targets patients with confirmed or suspected HSV esophagitis in whom severe odynophagia is the defining feature — painful swallowing of a degree that limits oral intake and drives the need for escalated, hospital-level care.
Management centers on hospitalization to initiate parenteral antiviral therapy. The primary clinical goal is quick improvement of odynophagia. Patients who respond early may be candidates for a transition to a different route of administration — the full regimen, sequencing, and transition criteria are available in the complete protocol.
DOI: 10.5114/pg.2013.39914
Patients with severe odynophagia may require hospitalization for parenteral acyclovir therapy 5 mg/kg 3 times a day for 1 to 2 weeks.
Those who improve quickly can be switched to oral therapy.
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