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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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Background: Herpes Zoster is a more sporadic disease than a doe’s primary VZV infection. Herpes Zoster is typically transmitted person to person by direct contact. The lifetime risk of developing Herpes Zoster is between 25% and 30%, rising to 50% in those aged at least 80 years. The aim is to identify the side effects of oral valacyclovir and oral acyclovir in the treatment of herpes zoster.Material & Methods:This randomized clinical trial was conducted in the Department of Dermatology and Venereology, ShaheedSuhrawardy Medical College and Hospital, Dhaka, from April 2016 to September 2016. A total of 60 patients with herpes zoster were enrolled in the study. Group A Valacyclovir was 30 patients, and Group B Acyclovir was 30 patients.Results:In Group-A, it was observed that 6(20.00%) patients had nausea found to be the highest, 4(13.33%) patients had Headache, 3(10.00%) patients had vomiting, 2(6.67%) patients had Diarrhea,0(0.00%) patients had anorexia, 3(10.00%) patients had abdominal pain, and 1(3.33%) patients had dyspepsia found to be lowest in Group-A, and 8(26.67%) patients had nausea found to be highest, 5(16.67%) patients had Headache, 4(13.33%) patients had vomiting, 3(10.00%) patients had Diarrhea,1(3.33%) patients had anorexia, 5(16.67%) patients had abdominal pain, and 1(3.33%) patients had dyspepsia found to be lowest in Group-B of study patients as side effects.Conclusion:The rate of cessation of abnormal sensations, rash healing, and complications or adverse effects was not similar with both the treatments. There were no clinically significant differences in the nature and frequency but there were clinically significant differences in severity of adverse/side events between the two treatment groups. Thus, we conclude that in the management of herpes zoster, valacyclovir accelerates the resolution of pain and offers simpler dosing, and maintains a favorable safety profile than acyclovir.
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Resumen Presentamos el caso de un varón de 63 años, inmunocompetente, con una necrosis retinal aguda (NRA) unilateral. Consultó por visión borrosa, dolor ocular, fotofobia y cefalea. Se confirmó una papilitis y coriorretinitis periférica asociada a vasculitis e isquemia retinal periférica. El estudio molecular por RPC de humor acuoso detectó la presencia de virus varicela zoster. El paciente fue tratado con terapia combinada con corticoesteroides orales, aciclovir oral/intravenoso, ganciclovir intravítreo semanal y luego valaciclovir oral por tres meses. Se demostró una disminución progresiva de la carga viral en el humor acuoso durante el tratamiento. El seguimiento mostró una mejoría del cuadro inflamatorio y una leve recuperación de la agudeza visual, sin embargo, finalmente presentó un desprendimiento de retina con pérdida casi total de la visión unilateral. La NRA es una complicación infrecuente provocada por algunos virus herpes con mal pronóstico visual, desenlace que puede ser mejorado con un diagnóstico y tratamiento precoz con antivirales. El tratamiento prolongado permite evitar la recaída y el compromiso contralateral.
Abstract We present the case of a 63-year-old immunocompetent man with unilateral acute retinal necrosis (ARN). He consulted for blurred vision, eye pain, photophobia, and headache. Papillitis and peripheal chorioretinitis associated with vasculitis and peripheral retinal ischemia was confirmed. PCR from aqueous humor sample detected varicella zoster virus. The patient was treated with a combined therapy of oral corticosteroids, oral / intravenous acyclovir along with weekly intravitreous ganciclovir doses followed by oral valaciclovir for three months. A progressive decrease in viral load in aqueous humor was demonstrated during treatment. Follow-up showed improvement in the inflammatory condition and a slight recovery of visual acuity, however, finally he presented a retinal detachment with total loss of one-sided vision. ARN is an uncommon complication caused by some herpesviruses with a poor visual prognosis, an outcome that can be improved with early diagnosis and treatment using appropriate antivirals. Prolonged treatment reduces relapse frequency and fellow eye compromise.
Subject(s)
Humans , Male , Middle Aged , Retinal Necrosis Syndrome, Acute/diagnosis , Retinal Necrosis Syndrome, Acute/drug therapy , Herpesvirus 3, Human/genetics , Antiviral Agents/therapeutic use , Acyclovir/therapeutic use , Polymerase Chain Reaction , Follow-Up StudiesABSTRACT
PURPOSE: We report a case of herpes simplex keratitis after Descemet membrane endothelial keratoplasty (DMEK). CASE SUMMARY: A 67-year-old male underwent DMEK in his left eye due to pseudophakic bullous keratopathy. One week after DMEK, re-bubbling was performed due to partial detachment of Descemet's membrane at the corneal periphery. After re-bubbling, the cornea remained clear and the patient's visual acuity gradually improved. Two months after DMEK, the patient presented with mild discomfort and decreased visual acuity. The cornea showed an irregular, narrow dendrite with an epithelial defect and surrounding opacity. After confirming that Descemet's membrane was attached, the patient was started on oral valacyclovir for suspected herpes keratitis. Herpes simplex virus type 1 was eventually identified by polymerase chain reaction. The corneal lesion resolved after three weeks of antiviral treatment. CONCLUSIONS: Similar to penetrating keratoplasty, DMEK can trigger outbreaks of herpes simplex keratitis. Herpes simplex keratitis should remain on the clinician's differential diagnosis for patients who present with a corneal epithelial irregularity and decreased visual acuity following DMEK.
Subject(s)
Aged , Humans , Male , Cornea , Corneal Transplantation , Dendrites , Descemet Membrane , Diagnosis, Differential , Disease Outbreaks , Herpes Simplex , Herpesvirus 1, Human , Keratitis , Keratitis, Herpetic , Keratoplasty, Penetrating , Polymerase Chain Reaction , Visual AcuityABSTRACT
Ramsay Hunt syndrome is caused by reactivation of the varicella zoster virus in the geniculate ganglion of the sensory branch in the face and ears. It is characterized by peripheral facial palsy, ear pain, and vesicles in the auditory canal and auricle. We report on a first case of Ramsay Hunt syndrome in a patient with human immunodeficiency virus in Korea. The patient, a 40-year-old male, first presented with otalgia and ear fullness. On admission, he had right facial palsy of the peripheral type, otorrhea, headache, limited tongue movement, and right auricle vesicular eruptions. He had positive human immunodeficiency virus antibody and Western blot tests. His CD4 T cell count was 281/microL. The patient was treated with valacyclovir and steroid with highly active antiretroviral therapy. His symptoms and facial palsy improved with treatment.
Subject(s)
Adult , Humans , Humans , Male , Antiretroviral Therapy, Highly Active , Blotting, Western , Cell Count , Ear , Earache , Facial Paralysis , Geniculate Ganglion , Headache , Herpes Zoster Oticus , Herpesvirus 3, Human , HIV , Korea , TongueABSTRACT
Objective:To establish a Crownpak CR( +)-HPLC method for the determination of the content and related substance of valacyclovir hydrochloride dispersible tablets. Methods: A Crownpak CR( +) [4. 0 mm × 150 mm,5 μm,DAICEL CROWNPAK CR( +)] column was used,and the mobile phase was 0. 1% perchloric acid in water. The flow rate was 0. 75 ml·min-1 and the de-tection wavelength was 255 nm. Results: A good linear range of valacyclovir hydrochloride was 11. 25-180. 00 μg · ml-1 ( r =1. 000 0), and the average recovery was 99. 0%(RSD=0. 8%, n=9). A good linear range of alacyclovir was 0. 2-50μg·ml-1(r=1. 000 0), and the average recovery was 99. 3%(RSD=0. 6%, n=9). The content of the tablets from two pharmaceutical companies was 92. 7% and 97. 4%, respectively, that of acyclovir calculated by an external standard method was 0. 5% and 0. 4%, respectively, and that of D-valacyclovir calculated by a self-control method was 0. 9%. Conclusion:The method can effectively separate valacyclovir and D-valacyclovir, which is simple, accurate and reliable, and suitable for the quantity control of valacyclovir hydrochloride.
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Objective:To develop an HPLC method for the determination of valacyclovir hydrochloride capsules. Methods: An Inertsil ODS (250 mm × 4. 6 mm,5μm) column was employed with methanol-0. 02 mol·L-1 potassium dihydrogen phosphate solution (20∶80) as the mobile phase, the flow rate was 1. 0 ml·min-1, the detection wavelength was at 251 nm, the column temperature was 30℃,and the sample size was 20μl. Results:The linear range of valacyclovir hydrochloride was 2-40μg·ml-1 , the correlation coeffi-cient was 0. 999 9 and the average recovery was 99. 8%(RSD=0. 16%,n=9). Conclusion:The analytical method is simple, accu-rate and special, which can be used in the content determination and quality control of valacyclovir hydrochloride capsules.
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Background and purpose:Herpes zoster is a common adverse event associated with the use of bortezomib. The objective of this study was to evaluate the efifcacy of different therapeutic regimens of valacyclovir prophylaxis: continuously administration and intermittent administration. Methods: We retrospectively analyzed the efficacy, side effects, expense of valacyclovir and emotional states of 31 patients with multiple myeloma who received bortezomib and valacyclovir prophylaxis. Among them, 14 patients underwent continuously administration of valacyclovir, the other 17 patients underwent intermittent administration. Continuously administration was deifned as daily oral valacyclovir 600 mg without cessation during entire period of bortezomib treatment. Intermittent administration was deifned as patients received valacyclovir at a dose of 600 mg daily during chemotherapy, while discontinue valacyclovir at the intermission time of bortezomib treatment. Results: There were no herpes zoster in patients of 2 arms. Adverse events over grade 3 associated with valacyclovir were not observed. Intermittent administration of valacyclovir showed a superiority of economic beneift. The emotional status were depended on the therapeutic effects of multiple myeloma. For those relapsed or refractory patients, continuously administration of valacyclovir might aggravate depression and anxiety. Conclusion:Intermittent administration of valacyclovir at a dose of 600 mg daily appears to be an effective prophylaxis for herpes zoster in patients receiving bortezomib.
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BACKGROUND: Famciclovir and valacyclovir are antiviral agents commonly used to treat herpes zoster. These medications not only reduce the time to complete cessation of zoster-associated pain, but also aid in the healing of the herpes zoster skin lesions. However, only few studies have compared these antiviral agents. OBJECTIVE: We conducted a randomized clinical trial to evaluate the extent of pain relief and wound healing, and the rate of postherpetic neuralgia associated with these drugs during 4 weeks of treatment. METHODS: The study included 69 immunocompetent adult inpatients diagnosed with herpes zoster randomly divided into 2 groups based on the antiviral agent administered. Patient age, date of visit from rash onset, and rash severity at baseline were recorded. Famciclovir or valacyclovir were administered orally for 7 days. Patients reported pain levels through a visual analog scale (VAS) score, and pain durations were assessed on days 1, 3, and 7, and at weeks 2, 3, and 4. Crust formation and reepithelialization times of skin lesions were also recorded. RESULTS: VAS scores, pain durations, ratios of patients undergoing postherpetic neuralgia, and skin lesion healing rates did not differ significantly between the 2 groups. However, rash severity independently correlated with the extent of pain experienced. CONCLUSION: Famciclovir and valacyclovir are comparable to each other in resolving zoster-associated pain, postherpetic neuralgia, and zoster wound healing. Early antiviral treatment before expansion of the skin lesion would be helpful for rapid relief of herpes zoster pain.
Subject(s)
Adult , Humans , Antiviral Agents , Exanthema , Herpes Zoster , Inpatients , Neuralgia, Postherpetic , Skin , Visual Analog Scale , Wound HealingABSTRACT
Valacyclovir is an oral antiviral agent used in the treatment of herpesvirus infection. Although neuropsychiatric symptoms may accompany the use of this drug, valacyclovir is increasingly used to treat herpes zoster, as it is more effective when orally administered. This paper reports one case of neurotoxicity of valacyclovir in patients with end stage renal disease who were undergoing maintenance hemodialysis. Valacyclovir can induce life-threatening neurotoxicity, especially in end stage renal disease patients despite the appropriate dose reduction. Furthermore, Valacyclovir-induced neurotoxicity can be effectively managed by intensive hemodialysis.
Subject(s)
Humans , Herpes Zoster , Herpesviridae Infections , Kidney Failure, Chronic , Renal DialysisABSTRACT
Response of EBV infection to valacyclovir in HIV infected children has not been reported earlier. An 8 years old HIV infected girl with undetectable viral load and normal CD4 count on regular antiretroviral therapy presented with persistent fever, lymphadenopathy and pancytopenia due to Epstein Barr virus (EBV). The child responded to valacyclovir.
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Acyclovir a specific and selective inhibitor of herpes virus has been used safely and effectively. The bioavailability of the drug is low results in poor absorption of drug. Valacyclovir is the L- valyl ester prodrug of Acyclovir. It is used in the treatment of Herpes simplex virus and Varicella zoster virus. After oral administration it is rapidly converted to acyclovir in the Gastro intestinal tract and liver, which increases the bioavailability of acyclovir three to five times that of acyclovir alone.
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Objective To establish a rapid, sensitive and selective liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the determination of acyclovir (the metabolite of valacyclovir hydrochloride) in human plasma. Methods After addition of ganciclovir as internal standard (IS), plasma samples were prepared by one-step protein precipitation using acetonitrile as precipitant, followed by an isocratic elution with 0.1% formic acid 3.5μm) column. Detection was performed on a triple-quadrupole mass spectrometer utilizing electrospray ionization (ESI) interface operating in positive ion and selected reaction monitoring (SRM) mode with the precursor to product ion transitions m/z 226.2→152.1 for acyclovir and m/z 256.2→152.1 for the IS. Results The analytical results demonstrated a good linearity over the ranges from 0.005 to 4μg/mL (r=0.9999) for valacyclovir hydrochloride. The relative standard deviations (RSD) of intra-batch and inter-batch were less than 4.06% and 9.23%, respectively. The limit of detection and lower limit of quantification in human plasma were 2ng/mL and 5ng/mL, respectively. Conclusion The method was simple, sensitive, accurate and reproducible and has been successfully applied to a bioequivalence study of valacyclovir hydrochloride capsules in Chinese healthy male volunteers.
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Objective: To establish a rapid, sensitive and selective liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the determination of acyclovir (the metabolite of valacyclovir hydrochloride) in human plasma. Methods: After addition of ganciclovir as internal standard (IS), plasma samples were prepared by one-step protein precipitation using acetonitrile as precipitant, followed by an isocratic elution with 0.1% formic acid solution-methanol (95:5, v/v) on an Agilent ZORBAX SB-C18 (150 mmx2.1 mm i. d., 3.5 μm) column. Detection was performed on a triple-quadrupole mass spectrometer utilizing electrospray ionization (ESI) interface operating in positive ion and selected reaction monitoring (SRM) mode with the precursor to product ion transitions m/z 226.2→152.1 for acyclovir and m/z 256.2→152.1 for the IS. Results: The analytical results demonstrated a good linearity over the ranges from 0.005 to 4 μg/mL (r=0.9999) for valacyclovir hydrochloride. The relative standard deviations (RSD) of intra-batch and inter-batch were less than 4.06% and 9.23%, respectively. The limit of detection and lower limit of quantification in human plasma were 2 ng/mL and 5 ng/mL, respectively. Conclusion: The method was simple, sensitive, accurate and reproducible and has been successfully applied to a bioequivalence study of valacyclovir hydrochloride capsules in Chinese healthy male volunteers.
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Management of genital herpes is complex. Apart from using the standard antivirals, an ideal management protocol also needs to address various aspects of the disease, including the psychological morbidity. Oral acyclovir, valacyclovir or famciclovir are recommended for routine use. Long-term suppressive therapy is effective in reducing the number of recurrences and the risk of transmission to others. Severe or disseminated disease may require intravenous therapy. Resistant cases are managed with foscarnet or cidofovir. Genital herpes in human immunodeficiency virus-infected individuals usually needs a longer duration of antiviral therapy along with continuation of highly active anti retroviral therapy (HAART). Genital herpes in late pregnancy increases the risk of neonatal herpes. Antiviral therapy and/or cesarean delivery are indicated depending on the clinical circumstance. Acyclovir appears to be safe in pregnancy. But, there is limited data regarding the use of valacyclovir and famciclovir in pregnancy. Neonatal herpes requires a higher dose of acyclovir given intravenously for a longer duration. Management of the sex partner, counseling and prevention advice are equally important in appropriate management of genital herpes. Vaccines till date have been marginally effective. Helicase-primase inhibitors, needle-free mucosal vaccine and a new microbicide product named VivaGel may become promising treatment options in the future.
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Dealing with varicella often causes doubts to general practitioners and pediatricians. In this article the author summaries guidelines based on solid evidence to treat varicella and prevent the disease in susceptible contacts in different clinical scenarios and presents his personal point of view in those controversial aspects commonly resolved by the authorized opinión of experts.
El manejo de la varicela despierta, con alta frecuencia, dudas en los médicos generales y pediatras. En este artículo, el autor resume aquellas recomendaciones basadas en sólida evidencia, para tratar la varicela y prevenir la enfermedad en los contactos susceptibles de un caso índice, en diferentes situaciones clínicas. Además emite su personal punto de vista en aquellos aspectos que despiertan controversia y comúnmente son resueltos en base a la opinión de reconocidos expertos.