HSV infection acyclovir

A number of nucleoside analogs are active against primary and recurrent HSV infection. Acyclovir is the major therapy used for HSV encephalitis. It should be given intravenously at a dose of lOmg/kg every 8h for 14-21 days. It is usually well tolerated with few side effects. Valacyclovir and famciclovir are alternative drugs used for the treatment of HSV encephalitis (Griffiths, 1995 Stanberry et al., 2002,2004). For a description of these drugs see 5. 

Immunocompromised patients are at greatest risk for severe and recurrent HSV infections. Acyclovir, valacyclovir, and famciclovir have been used to prevent reactivation of infection in patients seropositive for HSV who undergo transplantation procedures or induction chemotherapy for acute leukemia. Immunocompromised individuals, such as patients with AIDS, who fail treatment or prophylaxis with recommended antiviral doses frequently demonstrate improved response with higher doses. If resistance is suspected or confirmed with recommended first-line antivirals, foscarnet is usually effective. However, its use is associated with a greater risk of serious... 

Zoster usually begins as radicular pain followed by localized erythematous rash and characteristic vesicles. Zoster usually remains confined to a limited number of dermatomes, but complications such as widespread cutaneous involvement and disseminated visceral zoster may occur. As in the treatment of HSV infections, acyclovir is the drug of choice for VZV infections. While an oral acyclovir regimen of 4 g/day is effective for the treatment of zoster in immunocompetent adults, the drug has not been fuUy evaluated in immunocompromised patients such as those with AIDS. For practical reasons, oral acyclovir, famciclovir, or valacyclovir is often used for localized zoster. However, careful monitoring for signs of progression of zoster is essential. AIDS patients with disseminated cutaneous or visceral zoster should receive treatment with intravenous acyclovir in doses of 30 mg/kg per day for at least 7 days or until all lesions are crusted. Acyclovir-resistant VZV infections have been reported in patients with AIDS." ... 

Oral acyclovir is effective in primary herpetic gingivostomatitis (600 mg/m four times daily for 10 days in children) but has only modest benefit in recurrent orolabial herpes. High-dose valacyclovir (2 g twice over one day) shortens the duration of recurrent orolabial herpes by 1 day. Topical acyclovir is modestly effective in recurrent labial and genital herpes simplex virus infections. Acyclovir prophylaxis (400 mg twice daily for one week) reduces the risk of recurrence by 73% in those with sun-induced recurrences of HSV infections. Acyclovir during the last month of pregnancy reduces the likelihood of viral shedding and frequency of cesarean section in women with primary or recurrent genital herpes. 

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