A Randomized Trial of Acyclovir for 7 Days or 21 Days with and without Prednisolone for Treatment of Acute Herpes Zoster

Wood, Martin; Johnson, Robert W.; McKendrick, Michael W.; Taylor, Julie; Mandal, B K; Crooks, Jane

doi:10.1056/nejm199403313301304

Cited by 362 publications

(63 citation statements)

References 12 publications

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“…In this context, the absence of adverse effects from cortisone treatment of patients with PFP caused by borreliosis is important to note [7]. Steroids are also not contraindicated in the management of herpes zoster but may rather serve to reduce acute pain and to speed healing of the vesicles [43]. In the future, extensive virologic and immunologic studies should enable us to further reduce the frequency of a diagnosis of ‘idiopathic’ PFP and to unravel possible mechanisms for therapeutic intervention.…”

Section: Discussionmentioning

confidence: 99%

Peripheral Facial Palsy: Etiology, Diagnosis and Treatment

Roob

Fazekas

Hartung³

1999

Eur Neurol

100

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Treatment options for peripheral facial palsy (PFP) are an often discussed problem in neurologic practice. Following a short description of the complex anatomy of the seventh cranial nerve we therefore review possible etiologies in the context of leading clinical signs, with idiopathic PFP or Bell’s palsy (BP) being most frequent. A rather typical clinical course of BP allows to focus differential diagnostic workup predominantly on the rapid identification of treatable infections such as with Herpes zoster or Borrelia burgdorferi. Neuroimaging studies are needed only in case of trauma, with slowly developing PFP or in the presence of associated signs and symptoms. As BP is characterized by an overall high rate of spontaneous recovery, major emphasis has to be put on avoiding complications by protecting the eye. Meta-analysis of four randomized controlled studies suggests a marginal benefit of steroids concerning eventual achievement of complete recovery. Beneficial effects of a combination of acyclovir and prednisone have also been claimed. While such therapies may be considered in patients with a presumptive bad prognosis, more general recommendations on medical treatment of BP will have to await further trials.

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Section: Discussionmentioning

confidence: 99%

Peripheral Facial Palsy: Etiology, Diagnosis and Treatment

Roob

Fazekas

Hartung³

1999

Eur Neurol

100

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“…It has been shown that acyclovir treatment speeds the healing of the rash to within 1-2 days and also relieves acute pain [8,14], but it does not prevent the occurrence of PHN [8,[15][16]. In addition, treatment with both acyclovir and corticosteroids has the same effect as treatment with acyclovir only [8,14,17]. Opioids and some antiepileptic drugs (e.g., gabapentin) are used to relieve acute pain, whereas tricyclic antidepressants are used for the prevention of PHN [8,18].…”

Section: Introductionmentioning

confidence: 99%

Risk factors in patients with herpes zoster infections: case-control study

et al. 2013

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AbstractThe aim of this study was to determine the prevalence of chronic disease and the risk factors for herpes zoster infection. In this case-control study medical records were collected from 55 patients who presented with herpes zoster and 54 patients in a control group who presented with gastroenterocolitis. Both groups were treated at the Clinic for Infectious Diseases, University Clinical Hospital Mostar from January, 2005 to December, 2010. When we compared the herpes zoster group with the control group, we did not demonstrate any significant difference in the overall prevalence of chronic diseases. However, the prevalence of diabetes and cancer was statistically higher when compared to the control group. A statistically significant difference in the number of cigarette smokers was not observed, whereas the number who consumed alcohol in the herpes zoster group was significantly higher compared to the control group. The correlation between alcohol and herpes zoster could help in solving the reactivation mechanism of VZV.

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“…50 years, have moderate to severe pain at presentation, and have no contraindications for its use. [49][50][51] Acute Hz-related pain can be controlled with the use of a short-acting narcotic analgesic agent (eg, oxycodone) given on a scheduled rather than on an as-needed basis, a 5% lidocaine patch, gabapentin or amitriptyline in addition to oral analgesic agents, oral prednisone in addition to an antiviral agent and an analgesic agent, an epidural injection of methylprednisolone acetate and bupivacaine (once or repetitive) in addition to an oral analgesic agent, ganglion blockade with bupivacaine and dexamethasone, and/or acupuncture. Topical capsaicin should not be used in patients with active Hz because it can exacerbate pain, but it can be used for the treatment of PHN.…”

Section: Treatmentmentioning

confidence: 99%

Herpes Zoster: Diagnostic, Therapeutic, and Preventive Approaches

Bader

2013

Postgraduate Medicine

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Herpes zoster (Hz), which generally presents as a localized, painful cutaneous eruption, is a common clinical problem, particularly among adults ≥ 50 years of age and immunocompromised patients. The diagnosis of Hz is mainly made clinically, except in patients with atypical manifestations or certain complications, such as central nervous system involvement, in which laboratory virologic testing is required. In addition to having a higher mortality rate, immunocompromised individuals have atypical and severe clinical findings and are at greater risk for complications and recurrence of Hz. Treatment of Hz includes the use of antiviral agents, analgesics for control of acute zoster pain, good skin care for healing, and prevention of secondary bacterial infection. Antiviral agents, preferably valacyclovir or famciclovir, should be started within 72 hours of onset to reduce the severity of the infection, the duration of the eruptive phase, and the intensity of acute pain. Herpes zoster has been associated with several complications, of which post-herpetic neuralgia (PHN) is the most common and debilitating. Varicella-zoster virus vaccine and early treatment with either famciclovir or valacyclovir are the only measures proven to prevent PHN. The options for treating PHN include topical agents, such as lidocaine patches, and systemic agents, such as the anticonvulsants gabapentin and pregabalin. Measures for preventing Hz include infection control through routine hand hygiene and appropriate use of isolation precautions and personal protective equipment; immunoglobulins, such as the varicella-zoster virus immunoglobulin and vaccine; and antiviral agents. The zoster vaccine has been shown to be effective in reducing the incidence of Hz and PHN. The vaccine is recommended for all individuals aged ≥ 60 years who have no contraindications, including individuals who report a previous episode of Hz.

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A Randomized Trial of Acyclovir for 7 Days or 21 Days with and without Prednisolone for Treatment of Acute Herpes Zoster

Abstract: In acute herpes zoster, treatment with acyclovir for 21 days or the addition of prednisolone to acyclovir therapy confers only slight benefits over standard 7-day treatment with acyclovir. Neither additional treatment reduces the frequency of postherpetic neuralgia.

Cited by 362 publications

References 12 publications

Peripheral Facial Palsy: Etiology, Diagnosis and Treatment

Peripheral Facial Palsy: Etiology, Diagnosis and Treatment

Risk factors in patients with herpes zoster infections: case-control study

Herpes Zoster: Diagnostic, Therapeutic, and Preventive Approaches

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