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Famciclovir

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361. The prevention and management of herpes zoster. (PubMed)

The prevention and management of herpes zoster. The burden of illness from herpes zoster (HZ) and postherpetic neuralgia (PHN) in the Australian community is high. The incidence and severity of HZ and PHN increase with age in association with a progressive decline in cell-mediated immunity to varicella-zoster virus (VZV). Antiviral medications (valaciclovir, famciclovir, aciclovir) have been shown to be effective in reducing much but not all of the morbidity associated with HZ and PHN

2008 Medical Journal of Australia

362. Acyclovir to prevent reactivation of varicella zoster virus (herpes zoster) in multiple myeloma patients receiving bortezomib therapy. (PubMed)

prophylactically to all symptomatic myeloma patients.A retrospective review of the records of 125 myeloma patients who were treated with bortezomib and who also received routine acyclovir prophylaxis at the dose of 400 mg daily in >80% of patients was undertaken. Alternatives, used in <20% of patients, were 200 mg of acyclovir, 250/500 mg of valacyclovir, or 500 mg of famciclovir administered daily. This was accompanied by patient education regarding the importance of compliance with these prophylactic

Full Text available with Trip Pro

2008 Cancer

363. Famciclovir treatment options for patients with frequent outbreaks of recurrent genital herpes: the RELIEF trial. (PubMed)

Famciclovir treatment options for patients with frequent outbreaks of recurrent genital herpes: the RELIEF trial. Recurrent genital HSV outbreaks are common among those suffering from the disease. Antiviral medications taken as suppressive therapy can reduce the frequency of these recurrences and reduce viral shedding occurring in between recurrences.To investigate the efficacy and safety of oral famciclovir as episodic (125 mg twice daily for 5 days) and suppressive (250 mg twice daily (...) ). There was no significant difference between treatments in total score of the RGHQoL or in subject satisfaction with treatment.This study demonstrated that, compared to episodic treatment, suppressive treatment with oral famciclovir may extend the time to symptomatic outbreaks in patients with frequent recurrences of genital herpes.

2008 Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology Controlled trial quality: uncertain

364. Single-day, patient-initiated famciclovir therapy versus 3-day valacyclovir regimen for recurrent genital herpes: a randomized, double-blind, comparative trial. (PubMed)

Single-day, patient-initiated famciclovir therapy versus 3-day valacyclovir regimen for recurrent genital herpes: a randomized, double-blind, comparative trial. Recurrent genital herpes is a major problem for patients worldwide. Early episodic treatment with short-course therapy is effective, often stopping progression of outbreaks. This study is the first head-to-head comparison of single-day famciclovir (1000 mg administered twice daily) versus 3-day valacyclovir (500 mg administered twice (...) daily) for episodic therapy in immunocompetent patients.In this multicenter, multinational, double-blind, parallel-group study, 1179 adults with a history of recurrent genital herpes were randomized 1:1 to receive either famciclovir or valacyclovir. Patients initiated treatment within 6 h after a recurrence. The primary objective was to establish noninferiority of single-day famciclovir, compared with a 3-day course of valacyclovir, in time to healing of all nonaborted lesions in a modified intent

Full Text available with Trip Pro

2008 Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Controlled trial quality: predicted high

365. 2-day versus 5-day famciclovir as treatment of recurrences of genital herpes: results of the FaST study. (PubMed)

2-day versus 5-day famciclovir as treatment of recurrences of genital herpes: results of the FaST study. The brief period of viral replication in recurrent genital herpes lesions suggests shorter therapeutic regimens may be as effective as standard 5-day courses.To demonstrate that a 2-day course of famciclovir 500 mg statim, then 250 mg twice daily was non-inferior to the standard 5-day course of 125 mg twice daily.Patients were randomly assigned either the 2-day or 5-day famciclovir course

2008 Sexual health Controlled trial quality: uncertain

366. Shingles

. [ ] The antivirals that are used are (adult dose): [ ] Aciclovir 800 mg five times a day for seven days (continuing until two days after crusting of lesions in those who are immunocompromised). Valaciclovir 1000 mg three times a day for seven days; or Famciclovir 500 mg three times a day for seven days (or ten days in immunocompromised individuals) or 750 mg once or twice a day for seven days. One review found a significant reduction in risk of pain with valaciclovir and famciclovir for management of herpes (...) zoster virus (HZV) including ophthalmicus. Valaciclovir or famciclovir were both shown to provide significant reduction in the risk of HZV-associated pain. [ ] An oral antiviral drug should be started within 72 hours of rash onset for: Anyone over the age of 50 years. People of any age with non-truncal involvement (eg, affecting the neck, limbs or perineum). Cases where there is moderate or severe pain or rash. Those with ophthalmic involvement. People who are immunocompromised. If it is not possible

2008 Mentor

367. Human Immunodeficiency Virus

to all individuals living with HIV, especially those with a CD count below 200/mm 3 . Secondary prevention CMV - use ganciclovir to prevent retinitis. Long-acting drug-release intravitreous implants have been shown to be cost-effective. Herpes simplex - may require temporary daily suppressive treatment with oral aciclovir. There are limited safety data for famciclovir and valaciclovir. Oral candidiasis - may require suppressive treatment with an antifungal agent. Salmonella - long-term therapy may

2008 Mentor

368. Genital Herpes in Pregnancy

, and famciclovir in the first trimester of pregnancy and the risk of birth defects. JAMA. 2010 Aug 25304(8):859-66. ; Third trimester antiviral prophylaxis for preventing maternal genital herpes simplex virus (HSV) recurrences and neonatal infection. Cochrane Database Syst Rev. 2008 Jan 23(1):CD004946. ; Herpes simplex virus infection in pregnancy. Infect Dis Obstet Gynecol. 20122012:385697. Epub 2012 Apr 11. ; Herpes simplex virus infection in pregnancy and in neonate: status of art of epidemiology, diagnosis

2008 Mentor

369. Herpes Simplex Genital

of infection usually causes less severe symptoms, which are more rapidly self-limiting. Options for management are: Supportive measures alone (as described above). Antiviral therapy as required (episodic treatment). Suppressive therapy. Episodic antiviral treatment Oral aciclovir, valaciclovir, and famciclovir have all been shown to reduce duration (by a median of 1-2 days) and severity of episodes of genital herpes. No advantage has been shown of one therapy over another. Short-course therapy has been (...) found to be equally effective as five-day treatment. The earlier the treatment is started, the more effective it is likely to be. Therefore, people with recurrent genital herpes should have a course pre-prescribed so they can start it as soon as they feel the earliest symptoms developing. BASHH advises the following short courses as options for first-line therapy: Aciclovir 800 mg three times daily for two days. Famciclovir 1 g twice daily for one day. Valaciclovir 500 mg twice daily for three days

2008 Mentor

370. Herpes Simplex Eye Infections

provide some symptomatic relief. Antibacterial ointment may prevent secondary infection of the lesions but its use is not widespread. Use of antiviral ointment is equivocal with conflicting evidence as to its efficacy in reducing keratitis. Epithelial keratitis - topical antiviral treatment is the norm - eg, aciclovir five times a day until at least three days after complete healing. Alternatives include famciclovir or oral antivirals (which have the benefit of not being toxic to the corneal

2008 Mentor

371. External Eye - Lashes Eyelids and Lacrimal System

occurs in the older patient population. The eyelid, conjunctiva, episclera, sclera, cornea and anterior chamber may all be involved. (Cutaneous involvement of the tip of the nose suggests an increased likelihood of ocular complications, as this area is served by the first division of the nerve: this is called Hutchinson's sign.) Treatment is with systemic antivirals (eg, famciclovir 750 mg od for 7-10 days). Management of the lid involves cool compresses and topical lubrication (topical antibiotics

2008 Mentor

372. Bacterial Conjunctivitis

antiviral treatment as soon as the diagnosis is made (eg, aciclovir, valaciclovir or famciclovir) . Refer for ophthalmic review. The eye and surrounding structures may also be affected and slit-lamp examination is needed to exclude corneal involvement or developing uveitis, scleritis, retinitis, neuritis and cranial nerve palsies. Possible sequelae include scarring and glaucoma. Molluscum contagiosum conjunctivitis [ ] This oncogenic virus generally infects the skin but occasionally spreads to mucous

2008 Mentor

373. Chemoprophylaxis in HIV

to all individuals living with HIV, especially those with a CD count below 200/mm 3 . Secondary prevention CMV - use ganciclovir to prevent retinitis. Long-acting drug-release intravitreous implants have been shown to be cost-effective. Herpes simplex - may require temporary daily suppressive treatment with oral aciclovir. There are limited safety data for famciclovir and valaciclovir. Oral candidiasis - may require suppressive treatment with an antifungal agent. Salmonella - long-term therapy may

2008 Mentor

374. Statement on travellers and sexually transmitted infections

days (at least) OR Azithromycin 500 mg PO daily or 1 g PO once per week for 3 weeks (at least) HSV-II For severe primary disease, IV acyclovir 5 mg/per kg infused over 60 minutes every 8 hours is optimal, with conversion to oral therapy when substantial improvement has occurred. (In addition to antiviral therapy, analgesia and laxativesmay be required.) (First episode) Acyclovir 200 mg PO five times/day x 5 to 10 days OR Acyclovir 400mg POTID x 7 to 10 days Famciclovir 250 mg PO TID x 5 days (...) OR Valacyclovir 1 g PO BID x 10 days HSV-II (recurrent) Valacyclovir 500 mg PO BID x 5 days OR Valacyclovir 1 g POQDx 3 days OR Famciclovir 125 mg PO BID x 5 days OR Acyclovir 200 mg PO 5x/day x 5 days OR Acyclovir 800 mg PO TID x 2 days (Suppressive therapy may also be considered.) Human papillomavirus (For external genital warts) Patient-applied: Imiquimod cream (5%) applied to warts QHS 3 x per week for up to 16 weeks (should be washed off after 6 to 8 hours) Podofilox (0.5% solution or gel) applied QHS

2006 CPG Infobase

375. UK National Guideline on the sexual health of people with HIV: sexually transmitted infections

Page 10 antiviral drugs that have been shown to successfully treat genital herpes include aciclovir, valaciclovir, and famciclovir [62]. These are also the drugs most commonly employed in the treatment of genital herpes in PWHIV. Because resistance to these agents is more common in those with HIV co-infection, drugs such as foscarnet, trifluorothymidine, and cidofovir have also been used [63,64]. First episode genital herpes In the absence of good immune function, primary genital herpes may (...) and the dose of herpes medication increased [65]. Definitive studies in PWHIV are lacking. First episode genital herpes in HIV-positive people should be treated with aciclovir 400 mg five times daily for 7-10 days. Alternative oral regimens include valaciclovir 1 gram twice daily for 10 days or famciclovir 250-750 mg x3/day for 10 days. (Evidence level IIb, B). In severe cases, initiating therapy with aciclovir 5-10 mg/kg body weight IV every 8 hours may be necessary. (Evidence level IV, C). Recurrent

2006 British Association for Sexual Health and HIV

376. Economic evaluation of antiviral therapy for the treatment of herpes zoster in immunocompetent adults

of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Famciclovir as drug therapy for patients with acute shingles and aged 18 years or older. Type of intervention Treatment. Economic study type Cost-effectiveness analysis. Study population Patients aged 18 years or older with acute shingles, who presented for treatment within 48 hours of rash onset. Setting Secondary and primary care. The economic (...) effectiveness and cost data The costing was retrospectively undertaken using a different patient sample than that used in the effectiveness analysis. Study sample It was not reported whether power calculations were used to determine the sample size. The original study consisted of 545 patients randomly allocated to famciclovir 250mg (n=134), famciclovir 500mg (n=134), famciclovir 750mg (n=138), or acyclovir 800mg (n=139). The clinical basis of this study was the trial findings for a subgroup of 117 patients

1997 NHS Economic Evaluation Database.

377. Can you have Herpes zoster without a rash? Can you have zoster with atypical lesions - bumps but not blisters? When (if at all) is it appropriate to treat such a case with aciclovir?

within 72 hours of the rash onset. o Aciclovir is much less expensive than other antivirals, but is taken five times a day. o If compliance is an issue: consider valaciclovir (taken three times a day) or famciclovir (taken once a day or three times a day). It warns: • “Renal impairment: the dose should be reduced in renal impairment.” [1] References 1. PRODIGY guideline on shingles and postherpetic neuralgia. Last revised July 2005. ( ) 2. New Zealand Dermatology Society. Shingles. December 2006

2007 TRIP Answers

378. Should fit non-immunocompromised adults with chickenpox have anti-viral Rx?

showed no important difference between aciclovir and placebo with respect to complications associated with chickenpox [Klassen et al, 2004]. We found no studies that assess the efficacy of famciclovir or valaciclovir for the treatment of chickenpox.” References 1) PRODIGY. Chickenpox. 2004 ( ) Answered 5 April 2006 Follow us: © 2019 Trip Database Ltd. company number 04316414. Trip is proud to be made in the UK.

2006 TRIP Answers

379. Is there any preventative action or treatment which helps with recurrent facial cold sores? Are any investigations indicated?

with placebo (P v 21/102 [21%] with placebo; P = 0.92). The third RCT (20 people with recurrent herpes labialis) found that aciclovir (400 mg twice daily for 4 months) led to 53% fewer clinical recurrences than placebo (P = 0.05). The fourth RCT (248 adults with a history of sun-induced recurrent herpes labialis) compared three different dosages of famciclovir (125, 250, and 500 mg) versus placebo. Treatment was given three times daily for 5 days, beginning 48 hours after exposure to artificial ultraviolet (...) light. The RCT found no significant difference in the number of lesions among the four groups (number of lesions reported as non-significant; P value not reported). However, it found that increasing the dose of famciclovir significantly reduced the size and duration of lesions, in a dose–response relation. Compared with placebo, the 500 mg dose, but not the other doses, significantly reduced the mean size of lesions and reduced the mean time to healing by 2 days (mean size of lesions: P = 0.04; mean

2006 TRIP Answers

380. What evidence is there for using prophylactic aciclovir for recurrent herpes simplex, on the face or gentials?

suppressive treatment. Intermittent suppressive therapy may be an option for some people, for example to ensure they do not have an attack during a specified period, for example a holiday. Aciclovir 400 mg twice a day, aciclovir 200 mg four times day, valaciclovir 250 mg twice daily, or valaciclovir 500 mg daily are equally effective for suppression of genital herpes. Safety and resistance data on long-term aciclovir therapy extends to 15 years. Famciclovir 250 mg twice a day is also effective

2004 TRIP Answers

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