ABSTRACT
Current guidelines for severe herpes simplex virus infection recommend 21 days of intravenous therapy. The thrice-daily administration of intravenous acyclovir makes it challenging to deliver as outpatient therapy. We describe 2 cases with confirmed or presumed neonatal herpes simplex virus encephalitis treated with acyclovir administered as a continuous-infusion at home and review the pharmacologic and clinical evidence for continuous infusions of acyclovir.
Subject(s)
Acyclovir/administration & dosage , Antiviral Agents/administration & dosage , Encephalitis, Herpes Simplex/diagnostic imaging , Encephalitis, Herpes Simplex/drug therapy , Infusions, Intravenous/standards , Acyclovir/standards , Acyclovir/therapeutic use , Antiviral Agents/therapeutic use , Brain/diagnostic imaging , Brain/virology , Feasibility Studies , Female , Humans , Infant, Newborn , Infusions, Intravenous/methods , Magnetic Resonance Imaging , Male , Treatment OutcomeABSTRACT
Herpes labialis is a common skin infective condition, worldwide, which is primarily caused by HSV-1. Recurrent episodes of herpes labialis, also known as cold sores, can be frequent, painful, long-lasting and disfiguring for infected patients. At present, there are two types of antivirals for the treatment of herpes labialis, topical and oral, which are available over the counter or as prescription-only. The aim of antiviral therapy is to block viral replication to enable shortening the duration of symptoms and to accelerate healing of the lesions associated with herpes labialis. This review examines the evidence for the effectiveness of current topical and oral antivirals in the management of recurrent episodes of herpes labialis. In most countries, oral antivirals for herpes labialis are available as prescription-only. However, in early 2010, the oral antiviral famciclovir was reclassified from prescription-only medicine to pharmacist-controlled status in New Zealand. The benefits and risks associated with moving an antiviral therapy for herpes labialis from prescription-only to pharmacist-controlled status are reviewed here, and the implications for patients, general physicians and pharmacists are considered.
Subject(s)
2-Aminopurine/analogs & derivatives , Antiviral Agents/pharmacology , Disease Management , Herpes Labialis/drug therapy , Herpesvirus 1, Human/pathogenicity , 2-Aminopurine/administration & dosage , 2-Aminopurine/economics , 2-Aminopurine/pharmacology , 2-Aminopurine/standards , Acyclovir/administration & dosage , Acyclovir/analogs & derivatives , Acyclovir/pharmacology , Acyclovir/standards , Administration, Oral , Administration, Topical , Antiviral Agents/administration & dosage , Antiviral Agents/standards , Drug Resistance, Viral , Drug-Related Side Effects and Adverse Reactions , Famciclovir , Herpes Labialis/diagnosis , Herpes Labialis/virology , Herpesvirus 1, Human/drug effects , Herpesvirus 1, Human/physiology , Humans , Nonprescription Drugs/administration & dosage , Nonprescription Drugs/pharmacology , Nonprescription Drugs/standards , Practice Guidelines as Topic , Prescription Drugs/administration & dosage , Prescription Drugs/standards , Risk Assessment , Treatment Outcome , Valacyclovir , Valine/administration & dosage , Valine/analogs & derivatives , Valine/pharmacology , Valine/standards , Virus Replication/drug effectsABSTRACT
HSV can cause oral lesions that exacerbate chemotherapy-related mucositis. Intravenous acyclovir is effective in preventing HSV reactivations, but expensive. Valacyclovir has good bioavailability and has not been studied for prophylaxis of HSV among PCT patients. We compared the efficacy and costs of valacyclovir in preventing HSV reactivation among HSV seropositive autologous progenitor cell transplantation (APCT) patients with historical controls in whom intravenous acyclovir or no HSV prophylaxis were used. Valacyclovir group: From October 1997 to April 1999 108 adult patients received valacyclovir 500 mg twice daily from day -3 of APCT until neutropenia recovery or day +30. Valacyclovir was switched to intravenous acyclovir in cases of oral intolerance (17 patients) or suspected HSV reactivation (five patients). Intravenous acyclovir group: From January 1996 to October 1997 43 patients received 5 mg/kg twice-daily intravenous acyclovir from day -3 until recovery from neutropenia. No prophylaxis group: 38 patients from January 1996 to October 1997 did not receive HSV prophylaxis. HSV reactivations were seen in 2.7%, 2% and 45% of patients in the valacyclovir, intravenous acyclovir, and no prophylaxis groups, respectively. Valacyclovir was well tolerated and was the least expensive strategy. Oral valacyclovir was as effective as intravenous acyclovir for the prophylaxis of HSV reactivation in APCT patients.
