Dawaa Reference

infectious

Herpetic gingivostomatitis (primary oral herpes)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

Herpetic Gingivostomatitis - StatPearls (NCBI Bookshelf NBK526068) - https://www.ncbi.nlm.nih.gov/books/NBK526068/ · Egyptian National Drug Formulary - Antimicrobial 2023 (acyclovir monograph) · MSF Essential Drugs 2024 - paracetamol (oral) · Herpetic gingivostomatitis - disease-level clinical article (herpetic-gingivostomatitis-full.txt) · Herpetic gingivostomatitis - disease-level clinical article (herpetic-gingivostomatitis-clinical.txt)

Verified against5 documents
  • Herpetic Gingivostomatitis - StatPearls (NCBI Bookshelf NBK526068) - https://www.ncbi.nlm.nih.gov/books/NBK526068/
  • Egyptian National Drug Formulary - Antimicrobial 2023 (acyclovir monograph)
  • MSF Essential Drugs 2024 - paracetamol (oral)
  • Herpetic gingivostomatitis - disease-level clinical article (herpetic-gingivostomatitis-full.txt)
  • Herpetic gingivostomatitis - disease-level clinical article (herpetic-gingivostomatitis-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (5)

  • Primary infection may be silent, but most children develop fever, poor appetite, irritability, and painful mouth sores [fever · irritability · mouth ulcers · poor appetite]
  • Malaise, tiredness, and swollen neck or jaw glands often accompany the mouth lesions [fatigue · malaise]
  • Recurrences begin with burning and itching before blisters appear in a limited area [blisters · itching · relapse]
  • The lesions recur in the same spot with every episode
  • Physical or emotional stress, illness, sunlight, or trauma can trigger a recurrence [relapse]

Signs — what you find (5)

  • The first sign is redness of the mouth and surrounding skin, followed by fast-spreading blisters on the gums, palate, and cheek and lip lining [blisters · redness]
  • Ulcers look flat and yellowish, roughly 2 to 5 mm across, bleed easily, and clear without a scar over two to three weeks
  • One in three patients who has a first episode goes on to have recurrent lesions
  • Recurrent lesions favour keratinised skin such as the lip border, skin around the mouth, or the hard palate
  • Recurrent episodes cause only mild malaise and gland swelling compared with the first infection [malaise]

Tests (5)

  • Diagnosis is usually clinical, based on the history and the appearance of the oral lesions alone
  • Direct immunofluorescence on ulcer scrapings or blister fluid can confirm the diagnosis when needed
  • A Tzanck smear confirms a herpesvirus is present but cannot tell HSV-1, HSV-2, and varicella-zoster apart
  • Viral culture isolation is the gold-standard confirmatory test
  • Antibody testing can show seroconversion but does not by itself make the diagnosis

If not this — what else fits (12)

  • Herpetic gingivostomatitis must be differentiated from herpes zoster
  • Herpetic gingivostomatitis must be differentiated from primary chickenpox
  • Herpetic gingivostomatitis must be differentiated from Behcet disease
  • Herpetic gingivostomatitis must be differentiated from herpetiform aphthae
  • Herpetic gingivostomatitis must be differentiated from erythema multiforme
  • Herpetic gingivostomatitis must be differentiated from acute necrotising gingivostomatitis
  • Herpetic gingivostomatitis must be differentiated from reactive arthritis
  • Herpetic gingivostomatitis must be differentiated from cytomegalovirus ulceration
  • Herpetic gingivostomatitis must be differentiated from traumatic ulcers
  • Herpetic gingivostomatitis must be differentiated from chemical or thermal burns
  • Herpetic gingivostomatitis must be differentiated from a factitial injury
  • Herpetic gingivostomatitis must be differentiated from vesiculobullous disease

SourceStatPearls "Herpetic Gingivostomatitis" - disease-level clinical article

Presentation findings are traced to the source above.

1

ACYCLOVIR

1st line

Strength200 mg

Formoral.liquid

Adult dose and duration

400 mg 3 times daily or 200 mg 5 times daily for 7 to 10 days (the formulary's adult mucocutaneous HSV regimen; this condition is overwhelmingly a disease of young children) x 7 to 10 days (adult); 7 days (child)

Paediatric dose

15 mg/kg/dose [child max 200 mg]

(Immunocompetent children: 15 mg/kg (up to 200 mg) 5 times daily for 7 days has been used in a few children 1–6 years of age. Note the frequency: FIVE times a day, not three. The formulary's separate HIV-infected schedule is 20 mg/kg (up to 400 mg) 3 times daily for 7–14 days.)

Dose by age
1 to 6 years:Immunocompetent: 15 mg/kg (up to 200 mg) FIVE times daily for 7 days. The HIV-infected schedule is different: 20 mg/kg (up to 400 mg) 3 times daily.
Dose by weight
3kg45 mg/dose
4kg60 mg/dose
5kg75 mg/dose
6kg90 mg/dose
7kg105 mg/dose
8kg120 mg/dose
9kg135 mg/dose
10kg150 mg/dose
11kg165 mg/dose
12kg180 mg/dose
13kg195 mg/dose
14kg200 mg/dose (capped)
15kg200 mg/dose (capped)
16kg200 mg/dose (capped)
17kg200 mg/dose (capped)
18kg200 mg/dose (capped)
19kg200 mg/dose (capped)
20kg200 mg/dose (capped)
21kg200 mg/dose (capped)
22kg200 mg/dose (capped)
23kg200 mg/dose (capped)
24kg200 mg/dose (capped)
25kg200 mg/dose (capped)
26kg200 mg/dose (capped)
27kg200 mg/dose (capped)
28kg200 mg/dose (capped)
29kg200 mg/dose (capped)
30kg200 mg/dose (capped)
31kg200 mg/dose (capped)
32kg200 mg/dose (capped)
33kg200 mg/dose (capped)
34kg200 mg/dose (capped)
35kg200 mg/dose (capped)
36kg200 mg/dose (capped)
37kg200 mg/dose (capped)
38kg200 mg/dose (capped)
39kg200 mg/dose (capped)
40kg200 mg/dose (capped)
41kg200 mg/dose (capped)
42kg200 mg/dose (capped)
43kg200 mg/dose (capped)
44kg200 mg/dose (capped)
45kg200 mg/dose (capped)
46kg200 mg/dose (capped)
47kg200 mg/dose (capped)
48kg200 mg/dose (capped)
49kg200 mg/dose (capped)
50kg200 mg/dose (capped)
Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (acyclovir monograph)

Why

Indication claim, disease article: a child with a working immune system who is in significant pain, or refusing to drink, can be given oral acyclovir provided they are seen inside the first 72 hours from the onset of the illness. Dose claim, Egyptian formulary, acyclovir monograph, under its HSV Gingivostomatitis / Oral heading: for immunocompetent children, 15 mg/kg to a ceiling of 200 mg, given 5 times daily for 7 days - a regimen it records as having been used in a small number of children aged 1 to 6. The formulary states the dose under this exact indication heading, so the indication and the dose come from named documents, not inference.

Cautions
  • TIME WINDOW - the disease article reserves acyclovir for a child seen inside the first 72 hours from when the illness began. Beyond 72 hours the card is supportive care, not antiviral.
  • Most children need no antiviral at all: herpetic gingivostomatitis is usually mild, settles on its own, and supportive care is generally enough.
  • Prescribing limit, Egyptian formulary: by mouth, no more than 20 mg/kg given 4 times a day, to a ceiling of 1 g daily, in a child of 2 years or over weighing 40 kg or less.
  • Contra-indication, Egyptian formulary: hypersensitivity to acyclovir, to valacyclovir, or to anything else in the preparation.
  • Egyptian formulary monitoring: on high-dose therapy, watch a child for toxicity to the nervous system and to the kidneys. Keep the child drinking.
  • Acyclovir CREAM is not a substitute here. The Egyptian formulary licenses the cream for one thing only - recurrent cold sores (herpes labialis) in immunocompetent children of 12 years and over, in adolescents and in adults - and not for primary gingivostomatitis, nor for the age group that gets it.
Egyptian brands
Egyptian brandManufacturerIndicative price
BORGAVIRAX 200MG/5ML SUSP. 125 MLBORG61.00 EGP
VIRUSTAT 200MG/5ML SUSP. 120 MLPHAROPHARMA61.00 EGP
VIRUSTAT 400MG/5ML SUSP. 100 ML? strength differs? different route - not oral liquidPHAROPHARMA75.00 EGP
ZOVIRAX D.S 400MG/5ML SUSP.100ML? strength differs? different route - not oral liquidGLAXO SMITHKLINE96.00 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Herpetic gingivostomatitis - disease-level clinical article (herpetic-gingivostomatitis-clinical.txt)

Why

Carries the admission criteria and the supportive-care measures the disease article states, which apply whether or not acyclovir is given.

Cautions
  • RED FLAG - a child who cannot drink enough to stay hydrated is admitted. Dehydration, not the virus, is what admits these children.
  • RED FLAG - the other stated reasons to admit: a child who is immunocompromised, one who develops eczema herpeticum, and HSV that has spread to cause encephalitis or pneumonitis.
  • Supportive care: a barrier cream on the lips, petroleum jelly for instance, has been suggested to keep the surfaces from sticking together while the gingivostomatitis is active. (Herpetic Gingivostomatitis - StatPearls - NCBI Bookshelf, NBK526068)
  • Safety-netting: manage the child at home, but watch closely for anything developing - trouble eating or drinking, or lesions that are getting worse. (Herpetic Gingivostomatitis - StatPearls - NCBI Bookshelf, NBK526068)
  • Counsel the family that recurrence is expected: of the children who go through a primary herpetic gingivostomatitis, one in three will go on to get the oral lesions again as cold sores, or herpes labialis.
3

PARACETAMOL

add-on - not a substitute

Strength120 mg

Formoral.liquid

Adult dose and duration

1 g 3 or 4 times daily (max. 4 g daily) - According to clinical response

Paediatric dose

15 mg/kg/dose [child max 500 mg]

(Child 1 month and over: 15 mg/kg 3 or 4 times daily (max. 60 mg/kg daily). Child under 1 month: 10 mg/kg 3 or 4 times daily (max. 40 mg/kg daily).)

Age restriction: minimum 1 month

Dose by weight
3kg45 mg/dose
4kg60 mg/dose
5kg75 mg/dose
6kg90 mg/dose
7kg105 mg/dose
8kg120 mg/dose
9kg135 mg/dose
10kg150 mg/dose
11kg165 mg/dose
12kg180 mg/dose
13kg195 mg/dose
14kg210 mg/dose
15kg225 mg/dose
16kg240 mg/dose
17kg255 mg/dose
18kg270 mg/dose
19kg285 mg/dose
20kg300 mg/dose
21kg315 mg/dose
22kg330 mg/dose
23kg345 mg/dose
24kg360 mg/dose
25kg375 mg/dose
26kg390 mg/dose
27kg405 mg/dose
28kg420 mg/dose
29kg435 mg/dose
30kg450 mg/dose
31kg465 mg/dose
32kg480 mg/dose
33kg495 mg/dose
34kg500 mg/dose (capped)
35kg500 mg/dose (capped)
36kg500 mg/dose (capped)
37kg500 mg/dose (capped)
38kg500 mg/dose (capped)
39kg500 mg/dose (capped)
40kg500 mg/dose (capped)
41kg500 mg/dose (capped)
42kg500 mg/dose (capped)
43kg500 mg/dose (capped)
44kg500 mg/dose (capped)
45kg500 mg/dose (capped)
46kg500 mg/dose (capped)
47kg500 mg/dose (capped)
48kg500 mg/dose (capped)
49kg500 mg/dose (capped)
50kg500 mg/dose (capped)
Dose source

MSF Essential Drugs 2024 - paracetamol (oral)

Why

Indication claim, disease article: hydration matters more than anything else in this illness, and controlling the pain is usually what makes it possible - so an analgesic by mouth, paracetamol among them, together with mouth rinses, is encouraged to settle the child enough to drink. Dose claim, MSF Essential Drugs 2024 paracetamol (oral), under its mild-pain and fever indications: a child of 1 month and over takes 15 mg/kg given 3 or 4 times a day, to a ceiling of 60 mg/kg daily. Analgesia here is not comfort alone - it is what keeps the child drinking.

Cautions
  • MSF: never go above the stated dose, and least of all in a child or an older patient. Paracetamol poisoning is severe, and what it destroys is the liver cells.
  • MSF: give it cautiously where the liver is impaired.
  • The dose comes down in a child with severe acute malnutrition: 10 mg/kg, and no more than 3 times in 24 hours.
  • Give the dose BEFORE offering fluids or food, so the child can actually swallow.
Egyptian brands
Egyptian brandManufacturerIndicative price
CETAMOL 120MG/5ML PEDIATRIC SYRUP 120 MLMEMPHIS8.50 EGP
PARAGESIC BABY 120MG/5ML 120ML SUSP.AMRIYA36.00 EGP
PARAMOL 120MG/5ML SYRUP 125MLMISR36.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral liquidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral liquidPHAROPHARMA5.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.