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Famciclovir

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181. 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

182. 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

183. 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

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. Herpes Simplex Encephalitis (Treatment)

a higher dose of valacyclovir make a difference. Some evidence indicated that placebo, as a prophylaxis, is more effective than prostaglandin E, but the risk of bias was unclear in all trials. [ ] If long-term suppressive therapy is needed, acyclovir or famciclovir can be used orally. Neonatal herpes simplex encephalitis Acyclovir in doses of 20 mg/kg IV every 8 hours (60 mg/kg/d) is currently recommended for neonatal HSE. This dosage is higher than that used in older children and adults (30 mg/kg/d

2014 eMedicine.com

186. 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. Herpes Simplex (Treatment)

. October 1999. Number 8:644-652. Pasternak B, Hviid A. Use of acyclovir, valacyclovir, and famciclovir in the first trimester of pregnancy and the risk of birth defects. JAMA . 2010 Aug 25. 304(8):859-66. . Brown ZA, Wald A, Morrow RA, Selke S, Zeh J, Corey L. Effect of serologic status and cesarean delivery on transmission rates of herpes simplex virus from mother to infant. JAMA . 2003 Jan 8. 289(2):203-9. . Freeman EE, Weiss HA, Glynn JR, Cross PL, Whitworth JA, Hayes RJ. Herpes simplex virus 2

2014 eMedicine.com

188. Herpes Simplex (Treatment)

dissemination and transmission. Intravenous, oral, and topical antiviral medications are available for treatment of HSV infection and are most effective if used at the onset of symptoms. Oral therapy can be given at the time of the episode or as long-term suppressive therapy. Treatment of herpes labialis and herpes genitalis generally consists of episodic courses of oral acyclovir, valacyclovir, and famciclovir. Oral antiviral medications may be used (off label) as therapy for other uncomplicated HSV (...) at the first sign of recurrence. Treatments with acyclovir, valacyclovir, and famciclovir have all been shown to reduce the duration of lesions by 1-2 days. A study of 701 patients comparing famciclovir to placebo showed a median time to resolution of 4-4.5 days in the famciclovir groups in comparison to 6.2 days in the placebo group. [ ] The dosing of valacyclovir and famciclovir is less cumbersome and more convenient, and both offer greater bioavailability. Episodic treatment for recurrent herpes

2014 eMedicine.com

189. Hairy Leukoplakia (Treatment)

requires high doses (800 mg 5 times per day) to achieve therapeutic levels. [ ] Valacyclovir (1000 mg 3 times a day) and famciclovir (500 mg 3 times a day) are newer antiviral drugs with higher oral bioavailability than acyclovir and can be dosed less often. Antiviral drugs inhibit productive Epstein-Barr virus (EBV) replication but do not eliminate the latent state of infection. Hairy leukoplakia often recurs several weeks after the cessation of antiviral therapy. Topical therapy with podophyllin

2014 eMedicine.com

190. 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

191. 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

192. Benign Cervical Lesions (Treatment)

Azithromycin 1 g PO or Doxycycline 100 mg PO bid for 7 d Erythromycin base 500 mg PO qid for 7 d or Erythromycin ethylsuccinate 800 mg PO qid for 7 d N gonorrhoeae Cefixime 400 mg PO or Ceftriaxone 125 mg IM or Azithromycin 1 g PO or Doxycycline 100 mg PO bid for 7 d Spectinomycin 2 g IM or Ceftizoxime 500 mg IM or Cefotaxime 500 mg IM or Cefotetan 1 g IM or Cefoxitin 2 g + probenecid 1 g PO HSV Acyclovir 400 mg PO tid for 7-10 d or Acyclovir 200 mg PO 5 times/d for 7-10 d or Famciclovir 250 mg PO tid (...) or Acyclovir 200 mg PO 5 times/d for 7-10 d or Famciclovir 250 mg PO tid for 7-10 d or Valacyclovir 1 g PO bid for 7-10 d T vaginalis Metronidazole 2 g PO or Metronidazole 500 mg bid for 7 d Contributor Information and Disclosures Author Khanh-Ha D Nguyen, MD, MPH Clinical Fellow in Medical Genetics, National Human Genome Research Institute, National Institutes of Health Khanh-Ha D Nguyen, MD, MPH is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Specialty Editor Board

2014 eMedicine.com

193. Cancers of the Oral Mucosa (Treatment)

. Acyclovir remains the primary treatment, but new agents, such as famciclovir, penciclovir, sorivudine, foscarnet, and other agents, may be needed in cases of acyclovir resistance. Homeostatic microbial communities are protective in health by preventing or interfering with the colonization of exogenous pathogens (colonization resistance). When oral tissues are irradiated, colonization resistance is practically abolished, and alteration of the oral microflora occurs, with increases in yeasts and some gram

2014 eMedicine.com

194. Pharyngitis, Viral (Treatment)

In an immunocompetent host, oral acyclovir, famciclovir, and valacyclovir decrease the duration of symptoms and viral shedding. In an immunocompromised host, these drugs decrease pain and viral shedding and accelerate healing of lesions. These drugs are helpful in severely afflicted patients. Acute retroviral syndrome Several unique considerations favor antiretroviral therapy during this phase of HIV infection. Treatment may limit the extent of viral dissemination throughout the body, attenuate the progress of HIV

2014 eMedicine.com

195. Cervicitis (Treatment)

not provide a high and sustained bactericidal level as compared with ceftriaxone, the preferred treatment choice. Acyclovir may be used for primary herpes infection, but it is not curative, and recurrences are common. Valacyclovir and famciclovir are alternatives. [ ] Recommendations for infection by Trichomonas organisms are as follows [ ] : Metronidazole, 2 g PO in a single dose, or Tinidazole, 2 g orally in a single dose Ensuring that the patient's sexual contacts receive the appropriate examination

2014 eMedicine Pediatrics

196. Herpes Simplex Virus Infection (Overview)

Immunofluorescent microscopy Brain biopsy Imaging studies: Computed tomography, magnetic resonance imaging See for more detail. Management Specific medical therapy for pediatric HSV infection involves antiviral medications. For neonates born either vaginally or by Caesarian section to infected mothers, determination of primary vs reactivation disease in the mother is necessary to guide duration of therapy. Antiviral agents used include the following: Oral acyclovir (most common) Oral famciclovir (a prodrug

2014 eMedicine Pediatrics

197. Esophagitis (Diagnosis)

complications Treatment of reflux esophagitis may include the following: Histamine-2 receptor antagonists (H2RAs) Proton pump inhibitors (PPIs) Cisapride (a gastroprokinetic agent) Sucralfate (a coating agent) Treatment of infectious esophagitis is directed at the underlying cause, as follows: Fungal esophagitis – Topical, oral, or parenteral antifungals HSV esophagitis – Acyclovir, foscarnet (for acyclovir-resistant cases), or famciclovir CMV esophagitis – Ganciclovir and foscarnet HIV esophagitis – Oral (...) corticosteroids in conjunction with antiretroviral therapy Varicella-zoster virus (VZV) esophagitis – Acyclovir, famciclovir, or foscarnet (for acyclovir-resistant cases) Epstein-Barr virus (EBV) esophagitis – Acyclovir Human papillomavirus (HPV) esophagitis – No treatment, in most cases; systemic interferon alfa, bleomycin, or etoposide Tuberculous esophagitis – Standard antituberculous therapy Bacterial esophagitis – Broad-spectrum beta-lactam antibiotics, usually with an aminoglycoside, adjusted

2014 eMedicine.com

198. Gynecologic Pain (Diagnosis)

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

199. Genital Herpes in Pregnancy (Diagnosis)

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

200. Chickenpox (Diagnosis)

of complications, the most common being varicella pneumonia. (See .) VZV can be isolated on vesicular fluid cultures, which provides a definitive diagnosis. Direct immunofluorescence has excellent sensitivity. (See .) Oral acyclovir should be considered for healthy persons at increased risk of severe varicella infections. Valacyclovir and famciclovir are other agents used in treatment. Intravenous acyclovir therapy is recommended for patients who are immune-suppressed or immune-compromised. Varicella-zoster

2014 eMedicine.com

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