Infections in immunocompromised patients

Acyclovir (Zovirax) and penciclovir (Denavir) are the only topical antiviral dragp currently available These dragp inhibit viral replication. Acyclovir is used in the treatment of initial episodes of genital herpes, as well as heqies simplex virus infections in immunocompromised patients (patients with an immune system incapable of fighting infection). Penciclovir is used for the treatment of recurrent herpes labialis (cold sores) in adults. 

Herpes simplex virus (HSV) /nfecf/ons Treatment of acyclovir-resistant mucocutaneous HSV infections in immunocompromised patients. 

Neonatal herpes simplex virus infection Treatment of neonatal herpes infections. Parenteral Treatment of initial and recurrent mucosal and cutaneous herpes simplex virus (HSV)-I and -2 and varicella-zoster virus (VZV/shingles) infections in immunocompromised patients. 

Chickenpox Although chickenpox in otherwise healthy children is usually a self-limited disease of mild to moderate severity, adolescents and adults tend to have more severe disease. Treatment was initiated within 24 hours of the typical chickenpox rash in the controlled studies, and there is no information regarding the effects of treatment begun later in the disease course. IV acyclovir is indicated for the treatment of varicella-zoster infections in immunocompromised patients. 

Ointment Management of initial episodes of herpes genitalis and in limited non-life-threatening mucocutaneous herpes simplex virus infections in immunocompromised patients. 

Aciclovir is phosphorylated preferentially by herpes simplex virus-coded thymidine kinase and following further phosphorylation aciclovir triphosphate interferes with herpes virus DNA polymerase and viral DNA replication. Aciclovir topical cream is indicated in the management of initial genital herpes and in limited non-life threatening mucocutaneous herpes simplex virus infections in immunocompromised patients. 

Prophylaxis of herpes simplex infection in immunocompromised patients. 

Acyclovir Mucosal and Cutaneous HSV Infection in Immunocompromised Patients ... 

Varicella Zoster Infection in Immunocompromised Patients In adults, 10 mg/kg IV infused at a constant rate over 1 hour, every 8 hours for 7 days In children under 12 years of age, 20 mg/kg IV at a constant rate over 1 hour, every 8 hours for 7 days [Pg.27]

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. 

It is used in the treatment of cytomegalovirus infections in immunocompromised patients... 

Sordarin derivatives, (n), prepared by Balkovec (2) were effective in treating fungal infections caused by C. albicans and used in treating infections in immunocompromised patients. 

Daunorabicin (DaunoXome, Gilead Sciences, Inc.) Doxorubicin (Doxil/Caelyx, Ortho Biotech ProductsLP/Sequus Pharmaceuticals) Amphotericin B (Ambisome/Abelcet, Fujisawa Healthcare, Wyeth Pharmaceuticals) Doxorubicin (Myocet/Evacet, Sopherion/ Liposome Company) Hepatitis A virus envelope proteins (Epaxal, Berna Biotech) Influenza virus (Inflexal V, Berna Biotech) Verteporfin (Visudyne, Novartis Ophthalmics) Kaposi s sarcoma Kaposi s sarcoma Fungal infections in immunocompromised patients Metastatic breast cancer Hepatitis A Influenza Age-related macular degeneration... 

CICLOSPORIN OESTROGENS Possibly t plasma concentrations of cidosporin Estradiol and immunosuppressants are substrates of CYP3A4 and P-gp. Estradiol is an inhibitor of P-gp Monitor blood cidosporin concentrations. Monitor renal fundion prior to concurrent therapy. Be aware that infections in immunocompromised patients carry a serious threat to life... 

Saral R Candida and Aspergillus infections in immunocompromised patients An overview. Rev Infect Dis 1991 13 487 92. 

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). 

Resistant organisms. Initial resistance occurs in about 4% of isolates in the UK, usually to isoniazid. Multiple-drug-resistant tuberculosis, i.e. resistant to rifampicin and isoniazid at least, should be treated with three or four drugs to which the organisms are sensitive and should extend for 12-24 months after cultures become negative. Treatment of such cases requires expert management. Atypical mycobacteria are often resistant to standard drugs their virulence is low but they can produce serious infection in immunocompromised patients which may respond, e.g. to clarithromycin or a quinolone, often in combination. 

Acyclovir is useful for treating infections caused by HSV, herpes zoster, and for VZV infections (Whitley and Roizman, 2001). Although HCMV is relatively resistant to acyclovir, some cytomegalovirus infections have responded marginally to large doses of acyclovir, and it seems to be effective for the prophylaxis of cytomegalovirus infections in immunocompromised patients. Epstein-Barr virus is not sensitive to acyclovir, and clinical infections do not respond to the drug. 

Ribavirin is well absorbed orally, bnt it can be given in aerosol form for the treatment of respiratory syncytial virus (RSV) infections in immunocompromised patients, and in those with cardiopulmonary abnormalities, or in infants receiving mechanical ventilation (8,9). 

Ringden O, Meunier F, Toiiemar J, et ai. Efficacy of amphotericin B encapsuiated in iiposomes (AmBisome) in the treatment of invasive fungai infections in immunocompromised patients. J Antimicrob Chemother 1991 28 Suppi B 73-82. 

Rifabutin may be used in the prophylaxis of M. avium complex infections in immunocompromised patients and in the treatment, with other drugs, of pulmonary tuberculosis and non-tuberculous mycobacterial infections. 

Famciclovir Cytomegalovirus infections in immunocompromised patients only... 

---