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Dr. A. Clark
Dr. A. Clark, Pediatrician
Category: Pediatrics
Satisfied Customers: 4437
Experience:  33 years of experience as a general pediatrician in private practice and in pediatric urgent care.
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Hi my 11 month old baby developed stomatitis herpes at 4months

Customer Question

Hi my 11 month old baby developed stomatitis herpes at 4months old and has had a number of outbreaks of coldsores since then probably around 10 outbreaks but the current 1 is the worst he has not been without a coldsore now for about 8 weeks he has clusters at each side of his mouth and now that they are starting to clear up he had developed 1 on his botXXXXX XXXXXp and another area above his top lip. i've been to my Gp who treated him 3 weeks ago with aciclovir tablets but after the 5 day course he only had 2 days of a break then broke out in 3 different clusters around his mouth. Im so worried as to why he is continuously getting these sores and is there anything else i can do? Is this problem commen?
Submitted: 3 years ago.
Category: Pediatrics
Expert:  Dr. A. Clark replied 3 years ago.

Dr. A. Clark :

I'm happy that you have asked me to assist you with your child and hope that you can benefit from my many years of helping parents like you. It is not that common for infants to have so many recurrences and though the treatment is correct (acyclovir comes as a liquid however, so why the tablets?), I would be concerned that he is not responding from an immunological standpoint. I would ask that he have blood drawn for Quantitative Immunoglobulins to measure each component of the immune system's first and long term defenses to a challenge (IgA, IgM (first responders) and IgG which is the long term factor). If these are normal then he might benefit from daily acyclovir, which is a fairly safe medication even in infants, and works to prevent recurrences from occurring so often.

Dr. A. Clark :

I'm sure he had HSV Type 1 virus as the initial infection and what you are seeing is an atypical and unusual chronic recurrence but if his immune system is lacking in one of the essential components then he may not be responding to his immunizations or other infection challenges too. I'm sure he is normal however and this is just a rare recurrence in an young child but worth checking out with the blood test. Be sure he does quantitative not qualitative immunoglobulins.

Dr. A. Clark :

Acyclovir comes as a liquid in a 200mg/teaspoon preparation and I'm really unclear why he gave you tablets and how you are giving them.

Customer:

The tablet he gave me are soluable so i dissolved them and gave them that way. Apart from the coldsores he is generally a very healthy baby he was not sick for the 1st 6 months of life and has had a few colds and an ear infection only in last few months.

Dr. A. Clark :

I would worry that his dose is not quite getting to him since it is dissolved. The liquid would be preferable for titrating the exact dose.

Dr. A. Clark :

He would need a dose of 80 mg per kilogram of body weight, divided into 3-4 doses per day, or 20 mg/kg 4 times daily as the suppressive dose necessary to keep the outbreaks away.

Customer:

my family are concerned as to why these keep reoccurring without him gettin any breaks. He eats and drinks and they dont seem so annoy him very much but they just wont go away.

Dr. A. Clark :

I'm sorry, 20 mg/kg three times daily for suppression therapy.

Dr. A. Clark :

I am concerned too as this is unusual in children his age, hence my recommendation he have the blood test just to reassure everyone he doesn't have an immune defect.

Dr. A. Clark :

The cream may help some with the pain but he is probably just used to them!

Customer:

i cant remember the dose but he had 1 tablet dissolved in 5ml water and 2.5ml given 5 times per day. i have the aciclivor cream at mo and am using it

Dr. A. Clark :

It comes in 200,400 and 800 mg tablets.

Dr. A. Clark :

The 200 comes as a capsule, while the 400 and 800 are oval and pentagonal tablets.

Dr. A. Clark :

What does he weigh and what does the tablet look like?

Dr. A. Clark :

Generic 400 and 800 are oblong tablets.

Customer:

I cant rem because it was over 3weeks ago since he got them but they were small oblong white 1s. Do u think it is possible that he could have an immune problem when he is otherwise healthy and has responded to antibiotics for other infections

Dr. A. Clark :

Possible to have an immune problem that is just not presenting, especially if IgG deficient as it is the long-term immunity factor and that would affect how well he responds to vaccines. Don't be too concerned however as that is very rare and likely he would have had some other pretty serious infections by now. IgA deficiency is far more common and while untreatable, they do out grow it. The small oblong tablet is 400 mg, so you were giving him 200 mg per dose or for an average 11 month old who weighs 10 kg or so that would be fine, however I'm not sure how well it dissolves in water.

Dr. A. Clark :

I just looked up the FDA info on acyclovir tablets and it says the maximum that can be dissolved in water is 2.5 mg per ml, the rest does not dissolve. So if he only absorbed the dissolved portion he was getting a very low dose, though the undissolved granules would dissolve in the stomach. To be sure he is getting the right dose ask him to give you the suspension at 1 teaspoon (200 mg) 3 times daily and then you know he is getting the full dose and maybe it will work better.

Customer:

thankyou for this help. i was back with my gp today who seems to think im fussing he said he does not want to treat with acicl again because its best kept for when its really needed. he agrees that there are visable cold sores on the baby but is not concerned about the fact that they are constant

Customer:

He gave the acic cream and fucidin h cream for some of the red marks where the old cold sores were

Customer:

My fiance and i have never had a coldsore so this is frustrating

Dr. A. Clark :

One is always concerned about leaving anyone on a chronic medication longer than necessary. The nice thing about acyclovir is that it is very safe, even given to newborns IV, and for suppression must be given daily, just as I'm sure he does for his adult patients with chronic herpes (oral or genital) to prevent outbreaks. Unlike bacteria, viruses don't often develop resistance to this drug when used daily so it will always help. If he is not that bothered by them then I can see his point but I'd

Dr. A. Clark :

still do the bloodwork just to put our minds at ease.

Customer:

Ok i will look into it thanks again

Dr. A. Clark, Pediatrician
Category: Pediatrics
Satisfied Customers: 4437
Experience: 33 years of experience as a general pediatrician in private practice and in pediatric urgent care.
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Dr. A. Clark
Dr. A. Clark
Medical Director and pediatrician
4289 Satisfied Customers
33 years of experience as a general pediatrician in private practice and in pediatric urgent care.