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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

Antiviral treatment ineffective for Bell's palsy

The Cochrane Library has published an updated review of the available evidence for the use of antiviral agents in the treatment of Bell's palsy.

This review included data from seven trials involving 1,987 patients. This adds five new studies to the previous review. The analysis found no significant benefit in the rate of incomplete recovery from antiviral treatment compared with placebo. Additionally, antiviral treatment was significantly worse than corticosteroids although there were unexplained differences in the study populations. It was noted that there was no significant difference in rates of adverse events between antiviral treatments and placebo, antiviral treatments and corticosteroids or the antiviral-corticosteroid combination and placebo.

The analysis acknowledges that some studies have suggested that Bell's palsy may be caused by infection with the cold sore (herpes simplex) virus. However, since antiviral drugs appear to be clinically ineffective it is suggested that other causes for Bell's palsy should now be considered. Clinical Knowledge Summaries currently recommends prednisolone monotherapy for the treatment of Bell's palsy in adults presenting with 72 hours of symptom onset. The recommended dose is 25mg twice daily for 10 days.

Action: Clinicians should be aware of this review and avoid prescribing antiviral medication to treat Bell’s palsy.

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