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Famciclovir

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181. Viral Infections and Pregnancy (Overview)

the potential for a CMV vaccine to decrease maternal and congenital CMV infection. [ ] Pregnant women who are seronegative for HSV can prevent infection by abstaining from sex. An alternative would be the use of condoms and abstinence from oral-genital sex. As mentioned above, the results of several trials suggest that the use of acyclovir or famciclovir near term decreases the expression of genital herpes and, thus, the need for a cesarean delivery. VZV immunization in unexposed women or teenage girls

2014 eMedicine.com

183. Herpes Simplex (Treatment)

patients. Some physicians prescribe both oral and topical antiviral agents in conjunction when treating infectious HSV keratitis. Newer oral antiviral drugs, such as valacyclovir and famciclovir, further simplify the dosing regimens; however, the optimal dose for ocular disease has not been determined. Recurrence Patients with frequent recurrences of ocular HSV may be placed on a long-term regimen of oral antiviral medication at the prophylactic maintenance dose. Valacyclovir has been shown

2014 eMedicine.com

184. Herpes Zoster (Treatment)

electrical nerve stimulation. Although well-controlled studies are few, meta-analyses and clinical trials suggest that these treatments are effective in treating acute zoster-associated pain. [ , , ] Antiviral agents Many studies have found acyclovir and its derivatives (valacyclovir, famciclovir, penciclovir, and desciclovir, which is not available in the United States) to be safe and effective in treating active disease and preventing PHN. Their mechanism of action involves preventing VZV replication (...) through inhibition of viral DNA polymerase. [ , ] Valacyclovir and famciclovir are not approved by the for treatment of herpes zoster in children; acyclovir is more commonly used. Antiviral therapy may decrease the length of time for new vesicle formation, the number of days to attain complete crusting, and the days of acute discomfort. Usually, the earlier antiviral medications are started, the more effective they are in shortening the duration of zoster and in preventing or decreasing the severity

2014 eMedicine.com

185. Labyrinthitis and Related Conditions (Treatment)

function in patients with vestibular neuritis. [ ] This may also apply to the treatment of viral labyrinthitis. The antiviral drugs acyclovir, famciclovir, and valacyclovir shorten the duration of viral shedding in persons with herpes zoster oticus and may prevent some auditory and vestibular damage if started early in the clinical course. Administer corticosteroids to reduce inflammation and edema in the facial canal and labyrinth. Bacterial labyrinthitis For bacterial labyrinthitis, antibiotic

2014 eMedicine.com

186. Keratitis, Herpes Simplex (Treatment)

patients. Some physicians prescribe both oral and topical antiviral agents in conjunction when treating infectious HSV keratitis. Newer oral antiviral drugs, such as valacyclovir and famciclovir, further simplify the dosing regimens; however, the optimal dose for ocular disease has not been determined. Recurrence Patients with frequent recurrences of ocular HSV may be placed on a long-term regimen of oral antiviral medication at the prophylactic maintenance dose. Valacyclovir has been shown

2014 eMedicine.com

187. Dermabrasion (Treatment)

patients with postoperative breakthrough herpes simplex virus (HSV) infections may require a greater prophylactic dosage (ie, valacyclovir at 500-1000 mg/day for 10-14 days or famciclovir at 500-1000 mg/day for 10-14 days). Because the herpes virus requires viable epidermal cells to establish an infection, antiviral prophylaxis is continued for 10-14 days, which is longer than the time required for reepithelialization to occur. While most patients do not require antibiotic prophylaxis, patients who

2014 eMedicine.com

189. Cytomegalovirus (Treatment)

(eg, famciclovir, penciclovir, acyclovir) is preferred to treat VZV and herpes simplex infections. The major adverse effects of ganciclovir therapy include fever, rash, diarrhea, and hematologic effects (ie, neutropenia, anemia, thrombocytopenia). Neutropenia is managed by dose reduction and/or the addition of growth factors (ie, granulocyte colony-stimulating factor [G-CSF], granulocyte-macrophage colony-stimulating factor [GM-CSF]). Oral ganciclovir results in serum levels that are 5-10 times (...) cause changes in calcium and phosphorus metabolism. Other adverse effects include neurological toxicities, anemia, headache, and nausea. It can cause a fixed drug reaction on the penis. See the Medication section for dosing. Foscarnet does not require intracellular phosphorylation. Foscarnet resistance is secondary to mutations of the viral DNA polymerase involving codons from 696-845. Acyclovir prophylaxis High-dose valacyclovir, penciclovir, famciclovir, and acyclovir have been used for CMV

2014 eMedicine.com

190. Folliculitis (Treatment)

oral trimethoprim-sulfamethoxazole. Use of benzoyl peroxide washes may also be beneficial. Herpetic folliculitis responds to valacyclovir, famciclovir, or acyclovir. Papulopustular eruption associated with epidermal growth factor receptor inhibitors is self-limited and resolves with cessation of chemotherapy. In patients requiring treatment, topical antibiotics, topical corticosteroids or oral antibiotics, particularly tetracyclines, can be administered. Next: Consultations The patient's primary

2014 eMedicine.com

191. Genital Herpes in Pregnancy (Treatment)

to a decreased viral load or to immune suppression is unknown. Acyclovir has been labeled a category B drug (no teratogenic effects were found in animal studies, but no or limited human studies are available). Valacyclovir and famciclovir Since the introduction of acyclovir, newer second-generation antivirals have been introduced (eg, , ). Valacyclovir is identical to acyclovir except for the addition of an ester side chain that increases bioavailability. Once absorbed, it is converted to acyclovir in vivo (...) . This allows for higher serum levels with a less-frequent dosing schedule. Famciclovir is a nucleotide analogue that has a longer intracellular half-life. As with acyclovir, these second-generation agents have been used for treatment of symptomatic primary and recurrent lesions as well as for daily suppression. Both valacyclovir and famciclovir have been labeled category B drugs. The recommended dosages of the 3 antiviral agents are as follows: Table 2. Recommended Dosages of the Antiviral Agents

2014 eMedicine.com

192. Gynecologic Pain (Treatment)

during an outbreak, and cultures or PCR testing. Treatment includes acyclovir, famciclovir and valacyclovir for acute cases and for longer term prophylaxis. Prevention of secondary infection is also important. Bacterial infections can also be quite painful. Those include Streptococcus , and MRSA. Colon-based organisms may at times be problematic, especially in patients with fistulae, and/or Crohn’s Disease. Clinicians should also be aware vaginal infections can results in vulvar pain, secondary

2014 eMedicine.com

193. Esophagitis (Treatment)

. In six patients, the Candida samples were found to be fluconazole-resistant, whereas two samples had dose-dependent susceptibility to this agent. Herpes esophagitis Herpes simplex virus (HSV) esophagitis diagnosed at endoscopy is typically treated with acyclovir, foscarnet (for acyclovir-resistant cases), or famciclovir (an acyclovir analog). Cytomegalovirus esophagitis Cytomegalovirus (CMV) esophagitis is treated differently from HIV esophagitis. However, these two entities cannot be reliably (...) to for complete information on this topic. HIV esophagitis In contrast to CMV esophagitis, HIV esophagitis is treated with oral corticosteroid therapy, usually for longer than 1 month, in conjunction with antiretroviral therapy for HIV. Varicella-zoster virus esophagitis Varicella-zoster virus (VZV) esophagitis is typically treated with acyclovir, famciclovir, or foscarnet (for acyclovir-resistant cases). Epstein-Barr virus esophagitis Epstein-Barr virus (EBV) esophagitis is treated with acyclovir. Long-term

2014 eMedicine.com

194. Laser Tissue Resurfacing (Treatment)

cephalexin (500 mg PO qid), ciprofloxacin (500 mg PO bid), and azithromycin (Z-Pak). Topical antibiotic prophylaxis may result in dermatitis and should be avoided. Since laser skin resurfacing can activate latent herpes simplex infection or cause infection during reepithelialization, antiviral medications are prescribed. Surgeons begin treatment on the day before or on the day of laser resurfacing. Regimens include acyclovir (400 mg PO tid for 7 d), valacyclovir (500 mg PO tid for 7 d), and famciclovir

2014 eMedicine.com

195. Postherpetic Neuralgia (Follow-up)

neuralgia: a randomized controlled trial. JAMA . 1998 Dec 2. 280(21):1837-42. . Rowbotham MC, Davies PS, Fields HL. Topical lidocaine gel relieves postherpetic neuralgia. Ann Neurol . 1995 Feb. 37(2):246-53. . Tyring S, Barbarash RA, Nahlik JE, et al. Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia. A randomized, double-blind, placebo-controlled trial. Collaborative Famciclovir Herpes Zoster Study Group. Ann Intern Med . 1995 Jul 15. 123(2):89-96

2014 eMedicine.com

198. Polyarteritis Nodosa (Follow-up)

are stopped once seroconversion from hepatitis B e antigen to hepatitis B e antibody occurs or after clinical recovery is maintained for 2-3 months. Isolated case reports have demonstrated benefit from the combination of interferon-α2b and lamivudine [ , ] or the addition of famciclovir and granulocyte-macrophage colony-stimulating factor in patients in whom antiviral therapy alone could not seroconvert and clear their HBV infection. [ ] Critically ill patients who are not responding to treatment may (...) associated polyarteritis nodosa with a combination of prednisolone, alpha-interferon and lamivudine. J Hepatol . 2000 Oct. 33(4):677-83. . Wicki J, Olivieri J, Pizzolato G, Sarasin F, Guillevin L, Dayer JM. Successful treatment of polyarteritis nodosa related to hepatitis B virus with a combination of lamivudine and interferon alpha. Rheumatology (Oxford) . 1999 Feb. 38(2):183-5. . Molloy PJ, Friedlander L, Van Thiel DH. Combined interferon, famciclovir and GM-CSF treatment of HBV infection

2014 eMedicine.com

199. Polyarteritis Nodosa (Follow-up)

are stopped once seroconversion from hepatitis B e antigen to hepatitis B e antibody occurs or after clinical recovery is maintained for 2-3 months. Isolated case reports have demonstrated benefit from the combination of interferon-α2b and lamivudine [ , ] or the addition of famciclovir and granulocyte-macrophage colony-stimulating factor in patients in whom antiviral therapy alone could not seroconvert and clear their HBV infection. [ ] Critically ill patients who are not responding to treatment may (...) associated polyarteritis nodosa with a combination of prednisolone, alpha-interferon and lamivudine. J Hepatol . 2000 Oct. 33(4):677-83. . Wicki J, Olivieri J, Pizzolato G, Sarasin F, Guillevin L, Dayer JM. Successful treatment of polyarteritis nodosa related to hepatitis B virus with a combination of lamivudine and interferon alpha. Rheumatology (Oxford) . 1999 Feb. 38(2):183-5. . Molloy PJ, Friedlander L, Van Thiel DH. Combined interferon, famciclovir and GM-CSF treatment of HBV infection

2014 eMedicine.com

200. Laser Tissue Resurfacing (Follow-up)

cephalexin (500 mg PO qid), ciprofloxacin (500 mg PO bid), and azithromycin (Z-Pak). Topical antibiotic prophylaxis may result in dermatitis and should be avoided. Since laser skin resurfacing can activate latent herpes simplex infection or cause infection during reepithelialization, antiviral medications are prescribed. Surgeons begin treatment on the day before or on the day of laser resurfacing. Regimens include acyclovir (400 mg PO tid for 7 d), valacyclovir (500 mg PO tid for 7 d), and famciclovir

2014 eMedicine.com

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