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Editor: Helen M. Goodyear's letter (1) regarding our paper,
"Aciclovir in Herpes Simplex Gingivostomatitis" (2), was very critical but
it had only a remote relationship to the facts presented in the article.
The comment that the study involved a selected population referred to a
tertiary paediatric hospital is incorrect. Ninety-three percent of the
patients were identified by their primary paediatrician and referred to
our day care unit for the study; only 5 children were initially referred
to the emergency (casualty) department and hospitalized for IV
rehydration. Most of our cases of herpes gingivostomatitis are treated
out of hospital except for those associated with severe dehydration due to
low fluid intake and fever.
The children who were enrolled in the study were ill for less than 72
hours; indeed 84% had fewer than 20 lesions and were classified as having
mild or moderate disease. However, on follow-up, many of the children in
the placebo group had developed more lesions, and they were then entered
into the severe group by our definition. Most were followed on an
outpatient basis, except for 3 children who were hospitalized for
rehydration.
The effect of aciclovir treatment on long-term immunity against
herpes simplex is an important question. Despite the data showing some
decrease in immunity to herpes simplex after treatment of primary
infections with aciclovir (2), the use of this drug is a well-accepted
indication. The only available data on the immunological effect of primary
HSV Type 1 treatment with aciclovir are presented in our study.
Although based on a small number of children, the serological results
showed no difference between the aciclovir and placebo group in the
humoral immune response to the virus.
The recommendation of Dr. Goodyear to ensure that pain relief
medication is given in all cases of ginigivostomatitis is theoretically
reasonable but impractical. Topical anesthetics and mouthwashes are
generally distasteful and often logistically difficult to administer.
There are also no data on their effectiveness.
Jacob Amir, Head, Department of Pediatrics C, Schneider Children's
Medical Center of Israel, Petah Tikva, Sackler School of Medicine, Tel
Aviv University, Tel Aviv, Israel
References
1. Goodyear HM. Aciclovir in herpes simplex gingivostomatitis. BMJ
1997;315:1162.
2. Amir J, Harel L, Smetana Z, Varsano I. Treatment of herpes simplex
gingivostomatitis with aciclovir in children: a randomised double blind
placebo
controlled study. BMJ 1997;314:1800-3.
3. Bernstein DI, Lovett MA, Bryson YJ. The effects of acyclovir on
antibody
response to herpes simplex virus in primary genital hermetic infections.
J Infect
Dis 1984;150:7-13.
Jacob Amir, MD
Head
Department Pediatrics "C"
Competing interests:
No competing interests
10 November 1998
Jacob Amir
Head, Pediatrics "C"
Rabin Medical Center, Beilinson Campus, Petach Tikvah, Israel
HERPES SIMPLEX GINGIVOSTOMATITIS IS USUALLY NOT A CASUALTY DEPARTMENT PROBLEM
Editor: Helen M. Goodyear's letter (1) regarding our paper,
"Aciclovir in Herpes Simplex Gingivostomatitis" (2), was very critical but
it had only a remote relationship to the facts presented in the article.
The comment that the study involved a selected population referred to a
tertiary paediatric hospital is incorrect. Ninety-three percent of the
patients were identified by their primary paediatrician and referred to
our day care unit for the study; only 5 children were initially referred
to the emergency (casualty) department and hospitalized for IV
rehydration. Most of our cases of herpes gingivostomatitis are treated
out of hospital except for those associated with severe dehydration due to
low fluid intake and fever.
The children who were enrolled in the study were ill for less than 72
hours; indeed 84% had fewer than 20 lesions and were classified as having
mild or moderate disease. However, on follow-up, many of the children in
the placebo group had developed more lesions, and they were then entered
into the severe group by our definition. Most were followed on an
outpatient basis, except for 3 children who were hospitalized for
rehydration.
The effect of aciclovir treatment on long-term immunity against
herpes simplex is an important question. Despite the data showing some
decrease in immunity to herpes simplex after treatment of primary
infections with aciclovir (2), the use of this drug is a well-accepted
indication. The only available data on the immunological effect of primary
HSV Type 1 treatment with aciclovir are presented in our study.
Although based on a small number of children, the serological results
showed no difference between the aciclovir and placebo group in the
humoral immune response to the virus.
The recommendation of Dr. Goodyear to ensure that pain relief
medication is given in all cases of ginigivostomatitis is theoretically
reasonable but impractical. Topical anesthetics and mouthwashes are
generally distasteful and often logistically difficult to administer.
There are also no data on their effectiveness.
Jacob Amir, Head, Department of Pediatrics C, Schneider Children's
Medical Center of Israel, Petah Tikva, Sackler School of Medicine, Tel
Aviv University, Tel Aviv, Israel
References
1. Goodyear HM. Aciclovir in herpes simplex gingivostomatitis. BMJ
1997;315:1162.
2. Amir J, Harel L, Smetana Z, Varsano I. Treatment of herpes simplex
gingivostomatitis with aciclovir in children: a randomised double blind
placebo
controlled study. BMJ 1997;314:1800-3.
3. Bernstein DI, Lovett MA, Bryson YJ. The effects of acyclovir on
antibody
response to herpes simplex virus in primary genital hermetic infections.
J Infect
Dis 1984;150:7-13.
Jacob Amir, MD
Head
Department Pediatrics "C"
Competing interests: No competing interests