Acyclovir treatment of acute herpes zoster speeds rash healing and decreases pain and ocular complications. The limited oral bioavailability of acyclovir necessitates frequent dosing. Valaciclovir, the l-valyl ester of acyclovir, is rapidly and almost completely converted to acyclovir in vivo and gives three-to fivefold increases in acyclovir bioavailability. In a randomized, double-blind, multicenter study, the safety and efficacy of oral valaciclovir given at a dosage of 1,000 mg three times daily for 7 or 14 days and oral acyclovir given at a dosage of 800 mg five times daily for 7 days were compared in immunocompetent adults aged >50 years with herpes zoster. Patients were evaluated for 6 months. The intent-to-treat analysis (1,141 patients) showed that valaciclovir for 7 or 14 days significantly accelerated the resolution of herpes zoster-associated pain (P ‫؍‬ 0.001 and P ‫؍‬ 0.03, respectively) compared with acyclovir; median pain durations were 38 and 44 days, respectively, versus 51 days for acyclovir. Treatment with valaciclovir also significantly reduced the duration of postherpetic neuralgia and decreased the proportion of patients with pain persisting for 6 months (19.3 versus 25.7%). However, there were no differences between treatments in pain intensity or quality-of-life measures. Cutaneous manifestations resolved at similar rates in all groups. Adverse events were similar in nature and prevalence among groups, and no clinically important changes occurred in hematology or clinical chemistry parameters. Thus, in the management of immunocompetent patients >50 years of age with localized herpes zoster, valaciclovir given at 1,000 mg three times daily for 7 days accelerates the resolution of pain and offers simpler dosing, while it maintains the favorable safety profile of acyclovir.Herpes zoster remains an important medical problem throughout the world. The characteristic rash and associated pain occur when varicella-zoster virus, which becomes dormant in sensory ganglia following primary varicella-zoster virus infection, is reactivated, often in association with declining cellular immunity associated with advancing age (4). Thus, in otherwise healthy adults, the risk of herpes zoster increases with age (12). Pain persisting after rash healing occurs in more than 50% of untreated patients and is the major complication in older adults (3, 13). The pain is often accompanied by abnormal sensations such as allodynia, tingling, or numbness and decreases gradually over several months in most patients (2), although some patients have pain persisting beyond 6 months (8,13,20). Acyclovir (Zovirax) administered orally (800 mg five times daily) is widely used for treatment of acute herpes zoster. It speeds rash healing and decreases the severity of acute pain (14,18,25,28). In some studies, acyclovir also appears to reduce the prevalence, severity, and duration of chronic pain (7,11,14,18). Furthermore, oral acyclovir reduces the prevalence and severity of certain intraocular complications associated with herp...

Meta-analysis of four double-blind, randomized, placebo-controlled trials of oral acyclovir (800 mg five times daily) for the treatment of herpes zoster was conducted to provide definitive assessments of the effect of acyclovir on the resolution of zoster-associated pain. The studies involved a total of 691 patients, and the analysis was performed on an intent-to-treat basis. A range of milestones of pain cessation were evaluated by means of Cox regression models with adjustment for relevant prognostic factors. The proportion of patients with postherpetic neuralgia at 3 and 6 months was also determined. Advancing age and more severe pain at presentation were associated with more prolonged pain. Acyclovir was clearly shown to accelerate pain resolution by all of the measures employed. Benefit was especially evident in patients 50 years of age or older. Fewer acyclovir recipients had postherpetic neuralgia at 3 or 6 months. Overall, the reductions of pain duration and prevalence were approximately twofold.

This report demonstrates that long-term survival is achievable in patients with clinical PNI from cutaneous SCCHN after surgery and PORT. © 2015 Wiley Periodicals, Inc. Head Neck 38: 824-831, 2016.

Glycopeptide antibiotics, such as teicoplanin and vancomycin, are active against staphylococci (including methicillin resistant strains), streptococci, enterococci and Clostridium spp. Vancomycin and teicoplanin are both widely used in the treatment of infections caused by Gram-positive organisms. Vancomycin can, however, provoke a number of side-effects, and serum concentrations should be monitored during treatment. Teicoplanin has a longer half-life than vancomycin, it can be given as an intravenous bolus or by intramuscular injection, and nephrotoxicity and ototoxicity are relatively uncommon. Treatment with teicoplanin might, therefore, offer advantages over treatment with vancomycin-provided that similar clinical efficacy can be shown. At least 11 clinical trials comparing the efficacy and safety of teicoplanin and vancomycin have been carried out worldwide. Meta-analysis of the combined results from these studies indicates that more than three-quarters of the patients in each of the treatment groups had a clinical response to therapy. Meta-analysis of the numbers of adverse events occurring in each treatment group shows significantly fewer reports of adverse events in patients receiving teicoplanin (13.9%) than in those receiving vancomycin (21.9%). Direct comparisons are difficult because of inherent differences between studies, but available data suggest that teicoplanin is as effective as vancomycin and that its superior tolerability together with advantages such as once-daily bolus administration, intramuscular use and lack of requirement for routine serum monitoring, give it considerable potential for use in clinical practice.

Objectives As the pathophysiology of COVID-19 emerges, this paper describes dysphagia as a sequela of the disease, including its diagnosis and management, hypothesised causes, symptomatology in relation to viral progression, and concurrent variables such as intubation, tracheostomy and delirium, at a tertiary UK hospital. Results During the first wave of the COVID-19 pandemic, 208 out of 736 patients (28.9 per cent) admitted to our institution with SARS-CoV-2 were referred for swallow assessment. Of the 208 patients, 102 were admitted to the intensive treatment unit for mechanical ventilation support, of which 82 were tracheostomised. The majority of patients regained near normal swallow function prior to discharge, regardless of intubation duration or tracheostomy status. Conclusion Dysphagia is prevalent in patients admitted either to the intensive treatment unit or the ward with COVID-19 related respiratory issues. This paper describes the crucial role of intensive swallow rehabilitation to manage dysphagia associated with this disease, including therapeutic respiratory weaning for those with a tracheostomy.