Oral Acyclovir in the Treatment of Acute Herpes Zoster Ophthalmicus

Cobo, L. Michael; Foulks, Gary N.; Liesegang, Thomas J.; Lass, Jonathan H.; Sutphin, Jon; Wilhelmus, Kirk R.; Jones, Dan B.; Chapman, Stephanie; Segreti, Anthony; King, Dannie H.

doi:10.1016/s0161-6420(86)33678-9

Cited by 241 publications

(79 citation statements)

References 14 publications

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“…Furthermore, oral acyclovir reduces the prevalence and severity of certain intraocular complications associated with herpes zoster ophthalmicus (5, 11). The limited efficacies of lower oral doses of acyclovir (400 or 600 mg five times daily) relative to that of the standard dose suggests that efficacy is related to higher acyclovir concentrations in plasma or tissue (5,14). Thus, achievement of higher concentrations than are attained with the standard oral acyclovir regimen could result in improved benefit, particularly for pain outcome (26).…”

mentioning

confidence: 99%

Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults

Beutner

Friedman

Forszpaniak

et al. 1995

Antimicrob Agents Chemother

561

294

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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...

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mentioning

confidence: 99%

Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults

Beutner

Friedman

Forszpaniak

et al. 1995

Antimicrob Agents Chemother

561

294

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“…20 Treatment reduces the complication rate to ∼20%. 21 In the present study, the two year old boy with ophthalmic zoster was treated with acyclovir and recovered completely.…”

Section: Discussionmentioning

confidence: 65%

Herpes zoster in the pediatric age group: study from a tertiary care hospital

Lanker

Jeelani

2015

Int J Contemp Pediatr

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“…Al diagnóstico clínico del herpes zoster oftálmico debe acompañarle de forma inmediata una exploración oftalmológica que precise la posible afectación intraocular y su tratamiento precoz, para evitar en lo posible secuelas irreversibles como las opacidades corneales 1 0 . Los oftalmólogos instauran tratamiento con un antiviral vía oral en el herpes zoster oftálmico con o sin complicaciones 12,17 ( Fig. 1) -Debe derivarse al dermatólogo o internista, aquellos herpes zoster que: a) ocurren en pacientes con inmunosupresión severa; b) así como aquellos casos de herpes zoster en los que se detecten complicaciones del tipo de diseminación cutánea y visceral ( Fig.…”

Section: Criterio De Derivación Al Especialistaunclassified

Manejo del episodio agudo de herpes zoster y la neuralgia post-herpética

Pozo¹,

Gómez²,

González

2002

Medifam

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RESUMEN El herpes zoster es el resultado de la re a c t i v ación del virus de la varicela zoster, siendo más frecuente en pacientes con edad avanzada y con la in ABSTRACT Herpes zoster results from reactivation of the varicella-zoster virus. It is more commom in elderly and inmunocompromised patients. The clinical course of herpes zoster, in patients of Primary Health Care and younger than 60 years of age, is beningn and without complications. The main complication of herpes zoster is the postherpetic neuralgia, which is pain that appears in the affected INTRODUCCIÓNEl herpes zoster es el cuadro clínico constituido por las manifestaciones dermatológicas (erupción vesiculosa) y neurológica (dolor) que se produce por la reactivación del virus varicela zoster. El dolor es el síntoma más común por el que los pacientes con herpes zoster solicitan atención médica 1 .

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Oral Acyclovir in the Treatment of Acute Herpes Zoster Ophthalmicus

Cited by 241 publications

References 14 publications

Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults

Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults

Herpes zoster in the pediatric age group: study from a tertiary care hospital

Manejo del episodio agudo de herpes zoster y la neuralgia post-herpética

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