Are antivirals effective and safe in reducing the duration or severity of symptoms in herpes zoster infection?
EVIDENCE-BASED ANSWEROral antivirals are safe, with minimal adverse events (SOR: A, systematic review of randomized controlled trials [RCTs]). Oral acyclovir does not significantly reduce the incidence of postherpetic neuralgia (SOR: A, systematic review of RCTs). Valacyclovir and famciclovir may be more effective than acyclovir in reducing the risk of pain in herpes zoster (SOR: B, 2 systemic reviews of RCTs).
reduction in nonfatal strokes (3 trials; N5784; RR 0.40; 95% CI, 0.10-1.91), reduction of cardiovascular mortality (3 trials; N5784; RR 0.95; 95% CI, 0.48-1.86), or reduction of all-cause mortality (3 trials; N5785; RR 0.80; 95% CI, 0.51-1.25). The author noted that the scope of the study was heavily influenced by one small trail, thus limiting the validity of the results.A 2018 longitudinal cohort study (n516,678) investigated the relationship between estimated glomerular filtration rate (eGFR), albuminuria, and risk of cardiovascular and all-cause mortality in patients with type 2 diabetes. 2 Patients had a mean age of 60 years old, 47% female, and the majority had a duration of diabetes around 12 years. Patients were categorized by their baseline eGFR, which was calculated by serum creatinine according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Patients were further characterized by their Kidney Disease Improving Global Outcomes categories for eGFR and their degree of albuminuria by urine albumin to creatinine ratio categories. Cardiovascular disease hospitalizations occurred at a significantly higher rate in patients with macroalbuminuria compared with patients with normal albuminuria or microalbuminuria (18% vs 8.2% and 14% per 1,000 person-years, P,.5). The rate of all-cause mortality also occurred at a significantly higher rate in patients with macroalbuminuria compared with patients with normal albuminuria or microalbuminuria (39% vs 14% and 26% per 1,000 person-years, P,.05).A 2019 evidence-based clinical practice guideline from the American Diabetes Association recommended annual screening by assessing urinary albumin and eGFR in all patients with type 2 diabetes (level B: moderate supportive evidence from cohorts). 3 The guideline advocated for surveillance of albuminuria and eGFR to enable timely diagnosis of CKD, monitor progression of CKD, detect superimposed kidney diseases including acute kidney injury, assess risk complications, dose drugs appropriately, and determine whether nephrology referral is needed.
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