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Antiviral treatment is the core part in the treatment of herpes zoster. Based on the latest studies, consensus and guidelines, this article aims to provide a basis and reference for clinicians to make a reasonable choice of types and doses of antiviral agents. Valacyclovir, a precursor of acyclovir with high oral bioavailability and great convenience of administration, is generally the first choice of oral antiviral agents; for some special cases, such as immunocompromised patients, intravenous drips of acyclovir should be selected when appropriate. Brivudine is often a better choice for patients with severe renal insufficiency; famciclovir or other antiviral agents should be considered for patients resistant to acyclovir; for immunocompromised patients resistant to acyclovir, intravenous drips of foscarnet sodium can be an option. Oral antiviral agents should be administered at adequate doses. Selecting appropriate antiviral agents and their doses can effectively relieve acute symptoms of patients and reduce the probability of postherpetic neuralgia.
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Long-term use of immunosuppressant in kidney transplant recipients leads to poor immune function and infection with various pathogens. In recent years, along with the advancement of detection technique of human parvovirus B19 (HPV-B19) infection and the increasing quantity of kidney transplantation, the infection rate of HPV-B19 after kidney transplantation has been elevated year by year, becoming one of the major causes of pure red cell aplasia (PRCA), affecting the recovery of renal allograft function, and even leading to the injury or poor prognosis of renal allograft. To further standardize the diagnosis and treatment of HPV-B19 infection in kidney transplant recipients, Branch of Organ Transplantation of Chinese Medical Association and National Kidney Transplantation Quality Control Center jointly organized experts to formulate the clinical diagnosis and treatment specification for HPV-B19 infection after kidney transplantation from the perspectives of etiology, epidemiological characteristics, clinical manifestations, diagnosis, prevention, treatment, existing problems and prospects of HPV-B19, aiming to provide guidance for standardized prevention and treatment of HPV-B19 infection post-kidney transplantation in China.
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Objective To evaluate the diagnostic value of quantitative detection of cytomegalovirus (CMV) DNA from different sources [plasma, sputum and bronchoalveolar lavage fluid(BALF)] for CMV pneumonia after allogeneic hematopoietic stem cell transplantation. Methods Clinical data of 405 recipients undergoing allogeneic hematopoietic stem cell transplantation were retrospectively analyzed. Among them, 19 recipients diagnosed with CMV pneumonia were assigned into the CMV pneumonia group, and 229 recipients with CMV viremia alone, 11 recipients without CMV pneumonia who received fiberoptic bronchoscopy and 16 recipients diagnosed with bacterial or fungal pneumonia based on pathogenic evidence receiving sputum culture were assigned into the control A, B and C groups, respectively. The incidence of CMV pneumonia was summarized. The CMV DNA load of specimens from different sources (plasma, sputum and BALF) of recipients with CMV pneumonia was analyzed. The clinical prognosis of recipients with CMV pneumonia was evaluated. Results Among 405 recipients undergoing allogeneic hematopoietic stem cell transplantation, 19 cases developed CMV pneumonia, and the overall incidence of CMV pneumonia was 4.7%(19/405). The CMV DNA load in the plasma, sputum and BALF of recipients with CMV pneumonia was higher than those in the control A, B and C groups (all P < 0.05). In the 19 recipients, 12 cases were cured after antiviral treatment and 7 died from treatment failure(3 cases abandoned treatment). The fatality was 37%(7/19). Conclusions Quantitative detection of CMV DNA in the plasma, sputum and BALF may increase the diagnostic rate of CMV pneumonia, thereby improving clinical prognosis of recipients undergoing allogeneic hematopoietic stem cell transplantation.
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Objective@#To evaluate the therapeutic efficacy of penciclovir combined with foscarnet sodium in the treatment of herpes zoster.@*Methods@#The clinical datas of 135 herpes zoster patients from the ward of Department of Dermatology, Tianjin Medical University General Hospital were collected. Among them 64 patients received penciclovir and foscarnet sodium, and the remaining 71 patients only received penciclovir alone.Their general information, the time for vesicle stopped emerging, rash began to scab, pain to relief obviously, the adverse reaction and if they got the postherpetic neuralgia were recorded and included into statistical analysis.@*Results@#The general information showed no significant differences between the 2 groups(all P>0.05). The time for vesicle stopped emerging, rash began to scab, pain to relief obviously in combination group was shorter than the penciclovir group (all P<0.001). The number of patients who developed postherpetic neuralgia of combination group was fewer than that of penciclovir group(P=0.013). There was no statistical significance between the 2 groups the adverse reaction(P=0.928).@*Conclusions@#The penciclovir and foscarnet sodium combination therapy showed rapid therapeutic effects on herpes zoster patients, the incidence of postherpetic neuralgia was low, and there was no more side effects than penciclovir alone therapy. The combined therapy may be a reliable way to treat herpes zoster.
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OBJECTIVE: To establish a gradient ion chromatography method to determine the content of foscarnet sodium injection and its related substances. METHODS: The separation was performed on an Ionpac AG18 (4 mm×50 mm, 13 μm) + AS18 column (4.0 mm×250 mm, 7.5 μm) using potassium hydroxide produced by eluent generator (EG) as the mobile phase at a flow rate of 1 mL · min-1. Suppressed conductivity detection was adtopted. The column temperature was maintained at 30°C. RESULTS: The calibration curve of foscarnet sodium was linear between 2-100 μg · mL-1 (r=0.9998), and the calibration curves of the related substances were linear between 0.05-2 μg · mL-1 (r=0.9999 and r=0.9998). The intra-day and inter-day RSDs of foscarnet sodium were 0.35% (n=5) and 0.41% (n=5), respectively. The average recovery was 101%. CONCLUSION: The method is specific, sensitive and can be applied to determine the content and impurities of foscarent sodium injection.
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OBJECTIVE:To study the compatible stability of foscarnet sodium injection with5%glucose injection,10% glucose injection,glucose saline and NaCl injection.METHODS:The content changes of foscarnet sodium injection were determined by UV-spectrophotometry at different time within8h after mixing with 4 kinds of infusion solutions,the appearance description of the solution was observed,the pH value and the UV scan spectra changes of foscarnet sodium were determined.RESULTS:No marked changes were noted in the contents,appearance,pH value and the UV-scan spectra of the mixed solutions.CONCLUSION:Foscarnet sodium injection can be used with in 8h after mixing with 4 infusion solutions under the room temperature.
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To investigate the short term anti HBV efficacy of foscarnet sodium, sixty seven patients with various types of chronic hepatitis B were randomly divided into two groups. The experimental group (47 cases) was assigned to receive foscarnet sodium 3 0g by intravenous infusion twice daily in addition to general liver protective medicine for 15 days. The control group (20 cases) was treated with regular liver protective medicine only. The quantity of HBV DNA was measured with equivalent competitive PCR combining with DNA hybridization quantitative detection technique before and after treatment (once a week). The HBV markers and liver functions were also tested before and after treatment. In antiviral therapy group, the patients with different types of hepatitis B had their liver functions improved. HBV DNA in 13 patients became negative by PCR. Two of HBeAg positive patients became sero converted. Foscarnet sodium can inhibit HBV efficiently and quickly. The replication of HBV DNA can be greatly suppressed in the first week but without significant change in the second week in some cases. Foscarnet can be one of the drugs of choice in a combined therapy or as the initial drug in a sequential therapeutic regime.