Reasonable selection of antiviral agents for herpes zoster / 中华皮肤科杂志

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.

In vitro activity of six antiviral drugs against equid alphaherpesvirus type 1 indicates ganciclovir as promising drug for in vivo studies / A atividade in vitro de seis drogas antivirais contra o alfaherpesvírus equino tipo 1 indica que o ganciclovir é uma droga promissora para estudos in vivo

ABSTRACT: Equid alphaherpesvirus type 1 (EHV-1) is distributed worldwide and is a major agent of abortion, respiratory and neurological disease in horses. No specific treatment is available for EHV-1 infection, yet the potential of antiviral therapy has been explored. In this study we investigated the in vitro activity of Acyclovir, Ganciclovir, Foscarnet, Famciclovir, Vidarabina and Cidofovir against EHV-1. For this, the MTT test was performed, in which all the tested drugs showed no toxicity up to 200μg/mL. Subsequently, different drug concentrations were submitted to viral plaque reduction assays in cell culture. The selectivity index (SI) of the compounds was determined using the cytotoxic concentration for 50% of cells (CC50), obtained by MTT, and effective drug concentration to inhibit by 50% the number of viral plaques (EC50). Ganciclovir (SI: 490; EC50: 1.9 μg/mL) was the most efficient and safest drug against EHV-1, followed by Cidofovir (SI: 150, EC50: 5.7μg/mL), Acyclovir (SI: 37.4, EC50: 22.2μg/mL), Famciclovir (SI: 25.1, EC50: 24.5μg/mL), Vidarabine (SI: 12.2, EC50: 40.9μg/mL) and Foscarnet (SI: 6.9, EC50: 49.5 μg/mL), respectively. These results indicated that Ganciclovir (followed by Cidofovir), is a promising candidate for use in in vivo experiments.

RESUMO: O alfaherpesvírus equino tipo 1 (EHV-1) está amplamente distribuído nos rebanhos equinos de todo o mundo e é um dos principais agentes causadores de abortos, doença respiratória e neurológica em equinos. Ainda não há tratamento específico para a infecção pelo EHV-1 em equinos, mas o potencial da terapia antiviral tem sido investigado. Neste trabalho, foi investigada a atividade anti-herpética in vitro dos fármacos Aciclovir, Ganciclovir, Foscanet, Famciclovir, Vidarabina e Cidofovir frente ao EHV-1. Para isso, foi realizado o teste de MTT, em que todas as drogas não apresentaram citotoxicidade até a dose de 200μg/mL. A seguir, diferentes concentrações dos fármacos foram submetidas ao teste de redução de placas virais em cultivo celular. O índice de seletividade (IS) dos compostos foi determinado usando a concentração citotóxica para 50% dos cultivos celulares (CC50), obtida pelo MTT, e pela concentração dos fármacos efetiva para inibir em 50% o número de placas virais (EC50). O Ganciclovir (IS: 490; EC50: 1,9μg/mL) foi o mais eficiente e seguro frente ao EHV-1, seguido pelo Cidofovir (IS: 150; EC50: 5,7 μg/mL), Aciclovir (IS: 37,4; EC50: 22,2μg/mL), Famciclovir (IS: 25,1; EC50: 24,5μg/mL), Vidarabina (IS: 12,2; EC50: 40,9μg/mL) e Foscarnet (IS: 6,9; EC50: 49,5μg/mL). Estes resultados indicam que o Ganciclovir constitui-se em um candidato para uso em experimentos in vivo.

Venesection Ventouse Coordinated with Helium-neon Laser Combined with Drugs Treat Early Herpes Zoster / 浙江中医药大学学报

Objective]Observe the clinical effect of early herpes zoster which were treated by venesection ventouse combined with helium-neon laser and drugs. [Methods]The control group 32 cases used Famciclovir Tablet,transfer factor capsules,mecobalamin and acyclovir cream-drug for external use. While the experimental group 32 cases used Famciclovir Tablet,transfer factor capsules,mecobalamin and acyclovir cream-drug for external use. While the experimental group besides taking above-medicine, were treated with venesection ventouse and helium-neon laser at the pathological change. [Results]The control group used to cure for an average of 13 ±2.5 days. The experimental group used to cure for an average of 9.6 ±2.4 days. There were significant differences(P<0.05). [Conclusion] Early herpes zoster treated by venesection ventouse combined with helium-neon laser and drugs, can significantly shorten the duration of symptoms, alleviate suffering, and has good clinical efficacy.

Comparison between Famciclovir and Valacyclovir for the Treatment of Herpes Zoster in Adults / 대한피부과학회지

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.

The Treatment Experience Used Famciclovir in Herpes Zoster with Voiding Dysfunction in Female Patients

OBJECTIVE: Voiding dysfunction may be occurred due to the herpes zoster with lumbosacral lesion. We studied the clinical symptoms in patients with voiding dysfunction caused by herpes zoster. METHODS: We have investigated the medical records in 10 patients. These patients had urinary symptoms associated with herpes zoster. RESULTS: Dermatome levels were sacral(s) in 10 patients (s2, 4 patients; s3, 6 patients). Urologic symptoms were acute urinary retention in 10 patients who showed detrusor areflexia (7 patients) or detrusor hyporeflexia (3 patients) in urodynamics. All patients were managed by inserting catheter with alpha blocker. After 1 week we removed indwelling catheter. All patients were no problem in urination. CONCLUSION: The cause of voiding dysfunction is not known clearly in herpes zoster infection. But we investigated that Famciclovir 750 mg using oral medication and the urethral catheter insertion performed by one week was recovered from herpes zoster. Authors think it is useful for patients with impaired urination.

Sordera súbita: estudio retrospectivo sobre 40 casos ingresados en nuestro hospital / Sudden deafness: a retrospective study of 40 cases admitted to our hospital

Introducción: La sordera brusca es una pérdida súbita de audición a nivel neuro-sensorial, por causas desconocidas, y con mal pronóstico funcional. Las causas son desconocidas, lo que genera múltiples hipótesis y discusiones sobre esta patología. Objetivo: Evaluar los factores asociados al pronóstico y determinar los aspectos terapéuticos que influyen en el pronóstico de estos pacientes. Material y método: Revisamos las historias clínicas de los pacientes diagnosticados de sordera brusca durante un período de estudio de 4 años, y calculamos las frecuencias de las diferentes variables consideradas como relevantes; realizamos análisis bivariante y una comparación de las distribuciones mediante test de ANOVA y un análisis multivariante con regresión logística y lineal múltiple. Resultados: Analizamos 40 casos. Consideramos factores como el oído afectado, antecedentes cardiovasculares, HTA, diabetes, dislipemia, tabaco, hemoglobina, hematocrito, las circunstancias temporales y geográficas, de las que ninguna de ellas resultaron significativas para la recuperación. Tras el análisis de otros factores, encontramos un predominio de casos en verano y otoño (90 por ciento) frente a invierno y primavera (10 por ciento). El uso del famciclovir estuvo asociado a mayor probabilidad de recuperación completa OR 21,164 [1,265-374,47]. Por el contrario, estuvieron ligados a una menor probabilidad de recuperación completa: el tratamiento con medicina hiperbárica OR 0,013 [0,001-0,433], la curva audiométrica descendente OR 0,164 [0,032-0,533], y la presencia de vértigo asociada a acúfenos OR 0,158 [0,08-1,015]. La aspirina mejoró la recuperación de decibelios media 24,3 db IC 95 por ciento [1,00-47,61]. Conclusiones: El estudio es una serie retrospectiva cuyo análisis multivariante muestra que el famciclovir y el AAS tienen un efecto estadísticamente beneficioso en el tratamiento de la sordera súbita...

Introduction: The sudden deafness is a sudden loss of hearing at the neuro-senso-rial, for unknown reasons, and bad functional prognosis. The cause is unknown, generating multiple hypotheses and discussions on this topic. Aim: To evaluate the factors associated with prognosis and determine therapeutic aspects that influence the prognosis of these patients. Matherial and method: We reviewed the medical records ofpatients diagnosed with sudden hearing loss during a study period of 4 years, and calculate the frequencies of the different variables considered relevant; performed bivariate analysis and a comparison of the distributions byANOVA and a multivariate analysis with logistic regression and multiple lineal. Results: We analyzed 40 cases. We consider factors like the affected ear, cardiovascular history, hypertension, diabetes, dyslipidemia, snuff, hemoglobin, hematocrit, temporal and geographical, of which none were significant for recovery. After analysis of other factors, we found a predominance of cases in summer and autumn (90 percent) compared to winter and spring (10 percent). Use of famciclovir was associated with greater likelihood of complete recovery OR 21.164 [1.265 to 374.47]. On the contrary, were linked to a lower linked to a lower likelihood of full recovery: treatment with hyperbaric OR 0.013 [0.0010.0433] OR descending audiometric curve [0.164 0.032 to 0.533] and the presence of vertigo associated with tinnitus OR o.158 [0.08 to 1.015]. Aspirin improved recovery of 24.3 db decibel half 95 percent CI [1.00 to 47.61]. Conclusions: The study is a retrospective multivariate analysis which shows that famciclovir and aspirin have a statisfically beneficial in the treatment of sudden deafness, which in our sample is more frequent in summer and autumn. Biased studies are needed on these results may provide new hypotheses for treatment.

Newer trends in the management of genital herpes.

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.

Clinical Efficacy of Compound Glycyrrhizin Combined with Famciclovir for Herpes Zoster / 中国药房

OBJECTIVE:To observe the clinical efficacy of famciclovir combined with compound glycyrrhizin in the treatment of herpes zoster.METHODS:158 patients with herpes zoster were randomly divided into treatment group and control group(n=79).Treatment group was treated with famciclovir and compound glycyrrhizin for 7 days,and control group was given oral dose of famciclovir for 7 days.RESULTS:The regression time of the symptoms and signs in treatment group was significantly shorter than in control group (P0.05).CONCLUSION:Famciclovir combined with compound glycyrrhizin is superior to famciclovir alone in the treatment of herpes zoster.

The Effect of Oral Famciclovir in Pityriasis Rosea / 대한피부과학회지

BACKGROUND: Pityriasis rosea is a common, acute self-limiting papulosquamous disorder in which many studies suggest viral causative factors in its pathogenesis. Recently, the link between pityriasis rosea and the reactivation of human herpes virus-6 (HHV-6) and HHV-7 infection has been suggested. This evidence suggests that targetting HHV-6 or HHV-7 may be an effective treatment for pityriasis rosea. OBJECTIVE: We treated pityriasis rosea patients with oral famciclovir to investigate the effect of oral famciclovir in pityriasis rosea. METHODS: A case group of seventeen patients with pityriasis rosea were treated with oral famciclovir (250 mg 3 times daily for 7 days). Clinical evaluation at 0, 1 & 2 weeks was undertaken. A skin biopsy and polymerase chain reaction analysis of HHV-6 from a skin specimen were performed. We analyzed 19 patients with pityriasis rosea who were treated with topical steroid and oral antihistamines retrospectively and considered them as the control group. RESULTS: On the 7th day after oral famciclovir treatment was started, pityriasis rosea had regressed completely in 3 patients (17.6%) and had regressed partially in 9 patients (52.9%). On the 14th day, 12 patients (70.6%) had achieved more than partial regression. On the 7th day, systemic symptoms had improved in all 9 patients. Clearance of skin lesions was achieved in average 7.57 days in patients who had regressed completely after 14 days' treatment. Histological examination of patients was compatible with pityriasis rosea and polymerase chain reaction analysis of HHV-6 was negative in all 8 patients. Compared with the control group, the treatment for patients in the case group seemed to have better effects, but statistical analysis failed to show any significant differences between the two groups. CONCLUSION: Famciclovir was not effective in the treatment of pityriasis rosea, but further investigation is needed.