Antiviral prophylaxis

Few, if any, products are administered via the vagina that are intended for systemic absorption. Thus, this route has not been as widely studied and characterized as others. On the other hand, large numbers of different products (douches, spermicides, antiyeast agents, etc.) have been developed that require introduction into the vagina in order to assert their localized effects. Increased research into different birth control and antiviral prophylaxis will result in more vaginal products in the future. All these must be assessed for vaginal irritation potential, and this serves as an example of the other tissue tolerance issues. 

The use of trimethoprim-sulfamethoxazole in cancer patients at risk for P. jiwveci pneumonia has reduced the incidence of this protozoal infection substantially. Antiviral prophylaxis with acyclovir or newer agents (valacyclovir and famciclovir) is employed in most centers to reduce the risk of HSV reactivation in patients with acute leukemia undergoing intensive chemotherapy. Varicella vaccine provides good protection (90%) in leukemic children and also may be useful in seronegative adults, although the vaccine has been less well studied in this population. 

When considering use of antimicrobial (antibacterial, antifungal, antiprotozoal, and antiviral) prophylaxis in neutropenic patients with cancer, the risks and benefits of the prophylaxis versus issues with development of resistance, toxicities, and other concerns must be weighed. 

Ogata M, Satou T, Inoue Y, Takano K, Dcebe T, Ando T, et al. Foscamet against human herpesvirus (HHV)-6 reactivation after aUo-SCT breakthrough FlFlV-6 encephalitis following antiviral prophylaxis. Bone Marrow Transpl 2013 48(2) 257-64. 

When peeling off the face, herpes simplex reactivation is less likely and antiviral prophylaxis is not required. Due to the fact that all of the peeling agents have some degree of bacteriostatic activity, jxistprocedural antibiotics are not routinely prescribed. 

A new coronavirus was quickly identified after the outbreak of an atypical pneumonia in southern China early in 2003. The new virus eventually caused 8,000 infections with approximately 800 deaths in 29 countries. The condition was named Severe Acute Respiratory Syndrome, SARS, and the causative coronavirus named SARS-CoV. The zoonotic nature of the infection came with the identification of a similar virus in bats (Poon et al. 2005), although it is possible that the bat virus passed through other animal hosts and recombined with other SARS-like coron-aviruses prior to infecting humans (Hon et al. 2008). SARS-CoV is not currently circulating in the human population however, the mysterious appearance and rapid spread of this virus emphasized how vulnerable the human population is to such respiratory infections. This has spurred interest in the development of antivirals that could be used either in treatment or as prophylaxis to complement public health measures in curbing future outbreaks. 

Active labial HSV infection. Prescribe prophylaxis with oral antivirals in patients with relapsing HSV (2 days pre- and 5 days post-operatively)... 

In pharmacology, two adamantane derivatives. Amantadine (1-adamanta-neamine hydrochloride) and Rimantadine (a-methyl-1-adamantane methyla-mine hydrochloride) (see Fig. 24), have been well known because of their antiviral activity [129]. The main application of these drugs is prophylaxis (treatment to prevent the onset of a particular disease) and treatment of influenza-A viral infections. They are also used in the treatment of parkinsonism and inhibition of hepatitis-C virus. Memantine (1-amino-3,5-dimethyladaman-tane) (see Fig. 24) has been reported effective in slowing the progression of Alzheimer s disease [130]. 

Alemtuzumab is the antibody to the CD52 receptor present on B and T lymphocytes. The pharmacokinetics of alemtuzumab demonstrate a terminal half-life of 7 days. Alemtuzumab has shown clinical activity in the treatment of chronic lymphocytic leukemia. Severe and prolonged (6 months) immunosuppression may result, which necessitates prophylaxis with cotrimox-azole and antivirals to prevent opportunistic infections. 

Alemtuzumab Infusion-reactions fever, chills, nausea, vomiting rash Antiviral and PCP prophylaxis should be initiated... 

Antiviral drugs available for prophylaxis of influenza should be considered adjuncts but are not replacements for annual vaccination. 

The two classes of antiviral drugs available for treatment of influenza are the same as those available for prophylaxis and include the adamantanes, amantadine and rimantadine, and the neuraminidase inhibitors, oseltamivir and zanamivir. Because of widespread resistance to the adamantanes among influenza A viruses in the United States, amantadine and rimantadine are not recommended for treatment of influenza until susceptibility can be reestablished. 

Furuncles (boils) are caused by staphylococci. Fusidic acid is very effective against boils. Hydrocortisone is a lov/-potency corticosteroid. Aciclovir (antiviral) is indicated for the treatment and prophylaxis of herpes infections. Promethazine is an antihistamine cream and zinc oxide acts as a barrier v/hen used in creams. 

Aciclovir is an antiviral indicated in the treatment and prophylaxis of cold sores. It is available for systemic administration (tablets) or topical use (cream, eye ointment). In the management of cold sores, the cream is applied every 4 hours and continued for 5 days. Its use should be started as soon as symptoms (tingling sensation) begin. 

Rimantadine (Flumadine) [Antiviral] Uses Prophylaxis Rx of influenza A viral Infxns but not for HlNl swine flu Action Antiviral Dose Adults Feds >9 y. 100 mg PO bid Feds 2-9 y. 5 mg/kg/d PO, 150 mg/d max daily w/ severe renal/hepatic impair elderly initiate w/in 48 h of Sx onset Caution [C, -] w/ cimetidine avoid w/ PRG, breast-feeding Contra Component amantadine allergy Disp Tabs SE Orthostatic X BP, edema, dizziness, GI upset, X Sz threshold Interactions T Effects W/ cimetidine i effects W/ acetaminophen, ASA EMS Concurrent EtOH usage may result in light-headedness, confusion, syncope, and hypotension OD May cause N/V, tremors, Szs, anticholinergic Sxs, ventricular arrhythmias give IV fluids... 

Viral resistance develops rapidly in approximately 30% of individuals treated with amantadine or rimantadine. Resistant viruses are associated with the failure of drug prophylaxis in close contacts of infected individuals who have been treated with these antiviral agents. Mutation in the transmembrane domain of the M2 protein is the most frequent cause of resistance to amantadine and rimantadine. 

This chapter describes the basic characteristics of viruses and the relatively limited number of drugs that can act selectively as antiviral agents. Methods of preventing viral infections (antiviral vaccines) are also briefly discussed. Finally, the current methods of treating a specific viral-induced disease—AIDS—are presented. Rehabilitation specialists often treat patients who are in the active stages of a viral infection, as well as those suffering from the sequelae of viral disorders, such as gastroenteritis, encephalitis, and influenza. Hence, the pharmacotherapeutic treatment and prophylaxis of viral infections should concern physical therapists and occupational therapists. 

Other Bacterial vaccines and toxoids 1 Viral vaccines J Rickettsial vaccines Antisera Antiviral protein (interferon) Prophylaxis Therapy Chemotherapy Subunit vaccines sometimes available... 

Spermicide-antiviral the polymer appears to be an effective delivery system for the spermicidal/antiviral agent nonoxynol-9. By its ability to adhere to vaginal tissue while retaining nonoxynol-9 in its gel structure, it is an excellent extended effect spermicide. As an antiviral, nonoxynol-9 can only kill free HIV and is not noticeably active when the virus is within a lymphocyte. In contrast, the bioadhesive gel containing nonoxynol-9 attaches to lymphocytes and maintains sufficient contact time to allow the nonoxynol-9 surfactant to disrupt the cell wall, thus eliminating the lymphocyte and killing the vims within. This suggests that the polymer may be useful in the prophylaxis of AIDS and the treatment of other sexually transmitted diseases. 

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