This protocol covers herpes simplex esophagitis specifically in patients who do not have impairment of immunity — a distinct clinical situation that influences how the condition is managed.
In patients without impairment of immunity, HSV esophagitis may resolve spontaneously within one to two weeks. However, the clinical response can vary, and cases where the expected improvement does not occur require a different management strategy.
When the condition does not follow the expected course, a specific antiviral agent is available as a treatment option. The full regimen, decision criteria, and clinical pathway are in the complete protocol.
DOI: 10.5114/pg.2013.39914
Spontaneous resolution usually occurs after 1 to 2 weeks in patients without impaired immunity, although some may respond more quickly if treated with a short course of oral acyclovir 200 mg five times a day or 400 mg three 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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