Herpes simplex infections

Antiviral drugp interfere with viral reproduction by altering DNA synthesis. These drug are used in the treatment of herpes simplex infections of the eye, treatment in immunocompromised patients with cytomegalovirus (CMV) retinitis, and for the prevention of CMV retinitis in patients undergoing transplant. 

Bacterial and fungal complications in chemical peels are rare, since phenol is bacteriocidal and fungacidal. Patients with positive history of herpes simplex infection can be treated proph-ylactically with acyclovir or valacyclovir during the healing phase for 10 days. 

TABLE 77-3. Comparison of Antivirals used for Herpes Simplex Infection... 

The antiviral aciclovir cream is available as 5%. It is indicated in the treatment of herpes simplex infections. 

Vidarabine inhibits vitally induced DNA polymerase more strongly than it does the endogenous enzyme. Its use is now limited to topical treatment of severe herpes simplex infection. Before the introduction of the better tolerated acyclovir, vidarabine played a major part in the treatment of herpes simplex encephalitis. 

Genitai herpes Treatment or suppression of recurrent episodes of genital herpes. Herpes simpiex Treatment of recurrent mucocutaneous herpes simplex infections in HIV-infected patients. 

HIV-infected patients 500 mg twice daily for 7 days for recurrent orolabial or genital herpes simplex infection. 

Recurrent orolabial and genital herpes simplex infection in HIV-infected patients... 

Newer agents of this class are famciclovir and cidofovir. Famciclovir is a prodrug of penciclovir with improved oral bioavailability. It is labelled for the suppression of recurrent episodes of genital herpes in immunocompetent adults and for the treatment of recurrent mucocutaneous herpes simplex infections in HIV-infected patients. 

Chronic herpes simplex infection (orolabial, genital or anorectal of more than one month s duration)... 

For the prevention of recurrences of herpes simplex infection in immunocompetent patients. 

Docosanol Abreva Topical treatment of recurrent herpes simplex infections (cold sores]... 

Antiviral Efficacy and Clinical Use. Penciclovir (Denavir) is similar to acyclovir in terms of its antiviral effects and clinical indications. However, penciclovir is absorbed poorly from the gastrointestinal tract. This drug is primarily administered topically to treat recurrent herpes simplex infections of the lips and face (cold sores).58... 

Topical acyclovir (Zovirax) is available as a 5% ointment for application to primary cutaneous herpes simplex infections and to limited mucocutaneous herpes simplex virus infections in immunocompromised patients. In primary infections, the use of topical acyclovir shortens the duration of viral shedding and may decrease healing time. In localized, limited mucocutaneous infections in immunocompromised patients, its use may be associated with a decrease in the duration of viral shedding. 

Acyclovir is used in herpes simplex infection and should be administered as early as possible after the appearance of symptoms by the intravenous, oral, or topical route. Prolonged treatment reduces the recurrence but sudden withdrawal is dangerous, as the disease may recur. Acyclovir improves the healing of herpes zoster lesions and reduces pain. 

Foscarnet represents a diphosphate analogue. Incorporation of nucleotide into a DNA strand entails cleavage of a diphosphate residue. Foscarnet inhibits DNA polymerase by interacting with its binding site for the diphosphate group. Indications systemic therapy in severe cytomegaly infections in AIDS patients local therapy of herpes simplex infections. 

Comments on the generally favorable effects of lithium on immune function have been summarized (46). The antiviral and neuroprotective properties of lithium were mentioned in a review of the immune system and bipolar disorder (47). The potential benefit of lithium in treating AIDS and AIDS-related dementia, owing in part to its cytokine-regulating and neuroprotective effects, has been reviewed (48). Genital Herpes simplex infection has responded to lithium (49). 

Lithium compounds are under investigation for a number of additional medical uses. Salzman has reviewed 21 additional potential uses of lithium in psychiatry that have been reported in the literature. Lithium has been shown to inhibit herpes, pox and adenoviruses in vitro and lithium succinate ointment is useful in treating herpes simplex infections. Interestingly,... 

Uchoa UBC, Rezende RA, Carrasco MA, et al. Long-term acyclovir use to prevent recurrent ocular herpes simplex infection. Arch Ophthalmol 2003 121(12) 1702-1704. 

Herpes simplex infection in the immunocompromised host, especially the patient infected with the human immunodeficiency virus (HIV), requires careful comanagement with the patients physician. 

Conservative treatment of zoster-associated conjunctivitis, including cold compresses, lubricants, and decongestants, carries the lowest risk of treatment-related complications. Treatment of the acute conjunctivitis with topical broad-spectrum antibiotics may help to prevent secondary bacterial infection. Increased patient comfort by reduction of conjunctival inflammation may be affected by the use of topical steroids. Often, a combination antibiotic-steroid is used to accomplish both of these goals. In contrast to herpes simplex infection in which steroids are specifically contraindicated, topical steroids do not exacerbate herpes zoster infection. If steroids are used, the patient should be carefully monitored for intraocular pressure elevation. 

Parenteral acyclovir is the drug of choice for the treatment of initial and recuiTent mucosal or cutaneous herpes simplex infections in immunocompromised patients and for the treatment of disseminated, neonatal, encephalitic, and severe first episodes of genital herpes simplex infections in immunocompetent patients (Whidey, 1997). Ind avenous acyclovir should also be used for severe diseases such as encephalids (Brady and Bernstein, 2004). 

Valaciclovir is a prodrug (ester) of aciclovir, i.e. after oral administration the parent aciclovir is released. The higher bioavailability of valaciclovir (about 60%) allows dosing only 8-hourly. It is used for treating herpes zoster infections and herpes simplex infections of the skin and mucous membranes. 

Famciclovir is a prodrug of penciclovir which is similar to aciclovir it is used for herpes zoster and genital herpes simplex infections. It need be given ordy 8-hourly. Penciclovir is also available as a creeun for treatment of labial herpes simplex. 

A case of possible aciclovir-induced Stevens-Johnson syndrome has been reported in an HIV-positive patient with mycobacterial disease (21). However, Stevens-Johnson syndrome is associated with Herpes simplex infection and can be prevented by aciclovir (22). 

In a study of oral famciclovir versus oral aciclovir, designed to demonstrate equivalence of efficacy of the two drugs in the treatment of mucocutaneous Herpes simplex infection in HIV-infected individuals, there was no difference in the incidence or nature of adverse effects in the two groups (1). None of the withdrawals from the trial was considered by the investigator to be related to the study medication. 

In a randomized, placebo-controUed study in 455 patients oral famciclovir (125 or 250 mg tds or 250 mg bd) used to suppress recurrent genital Herpes simplex infections, the toxicity profile of famciclovir was comparable to placebo (4). The only serious adverse effects reported as being possibly related to famciclovir were raised bilirubin concentration and lipase activity in one patient after 10 months of treatment with famciclovir 125 mg tds. However, these laboratory abnormalities resolved on therapy after 7 days and did not recur during the rest of the study. 

Kinghorn GR, Woolley PD, Thin RN, De Maubeuge J, Foidart JM, Engst R. Acyclovir vs isoprinosine (immunovir) for suppression of recurrent genital Herpes simplex infection Genitourin Med 1992 68(5) 312-16. 

Reactivation of Herpes simplex infection after epidnral administration of opioids is well known. However, there have been reports of reactivation of Herpes simplex after intrathecal morphine for cesarean section (SEDA-17, 87) (SEDA-18, 84). 

Herpes simplex infection Herpes zoster infection Hirsutism (SEDA-6, 146)... 

Cidofovir is an acyclic nucleotide analogue of the monophosphate of cytosine. When phosphoiylated by host cellular enzymes, the active compound cidofovir diphosphate has broad activity against the herpes viruses, including CMV, HSV 1 and 2, VZV, Epstein-Barr virus, and the BK polyomavirus. Cidofovir has primarily been used in the treatment of CMV retinitis in patients who have failed treatment with ganciclovir or foscarnet and in acyclovir-resistant herpes simplex infections. More recently, there is also a growing experience with the use of this medication in kidney transplant patients who have BK virus-associated nephropathy [31], although this interest has been dampened by significant toxicity and only modest clinical activity [32]... 

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