HSV Esophagitis with Severe Odynophagia: When Parenteral Acyclovir Does Not Achieve Quick Clinical Improvement
Clinical Scenario
Patients with herpes simplex (HSV) esophagitis presenting with severe odynophagia who were hospitalised for parenteral acyclovir but did not show the expected quick clinical improvement. This pattern suggests infection with an acyclovir-resistant HSV strain and warrants escalation to a next-line approach.
Prior Treatment Line — Escalation Trigger
The first-line management for severe odynophagia in HSV esophagitis is hospitalisation for parenteral acyclovir. Failure to achieve quick clinical improvement of odynophagia is the threshold that triggers escalation to this protocol.
Next-Step Treatment (Partial Overview)
When acyclovir resistance is suspected, an alternative antiviral agent is available. The complete protocol — including selection criteria, dosing, route, and monitoring — is accessible via the link below.
References
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.
- Patients who do not respond to therapy probably are infected with a virus strain resistant to acyclovir resulting from mutations within the thymidine kinase or the DNA polymerase gene of HSV.
- In that case treatment with foscarnet can be an option.
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