At present, there are only a few indications of antiviral chemotherapy, with the high cost of antiviral drugs being a main consideration. Generally, antiviral chemotherapy is indicated where the primary infection is especially severe, where there is dissemination, where sight is threatened, and herpes simplex encephalitis.
Acyclovir – this the drug of choice for most situations at present. It is available in a number of formulations:-
I.V. (HSV infection in normal and immunocompromised patients)
Oral (treatment and long term suppression of mucocutaneous herpes and prophylaxis of HSV in immunocompromised patients)
Cream (HSV infection of the skin and mucous membranes)
Famciclovir and valacyclovir – oral only, more expensive than acyclovir.
Other older agents – e.g. idoxuridine, trifluorothymidine, Vidarabine (ara-A).
These agents are highly toxic and is suitable for topical use for opthalmic infection only