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Famciclovir

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121. Conjunctivitis, Allergic (Treatment)

(valacyclovir, acyclovir, famciclovir), as needed. Topical trifluridine (Viroptic) requires 9-times-per-day dosing and contains a thimerosal-based preservative, thereby exposing the already compromised ocular surface to unnecessary toxicity. A subset of patients with recalcitrant and debilitating AKC may benefit from plasmapheresis, as was described by Aswad in 2 patients, one of whom had hyperimmunoglobulinemia E. [ ] Penetrating keratoplasty may be undertaken in cases of severe corneal scarring

2014 eMedicine.com

122. Cutaneous Laser Resurfacing: Erbium:YAG (Treatment)

to reactivation of latent herpes simplex virus infection or predispose the patient to a primary infection during the reepithelialization phase of healing. It is recommended that prophylactic antiviral medication be prescribed during the postoperative period, regardless of a patient's herpes simplex virus history. Commonly used regimens include famciclovir 250 mg twice daily, acyclovir 400 mg 3 times a day, or valacyclovir 500 mg twice daily. The medication may be administered the day before, or morning

2014 eMedicine.com

123. Cutaneous Laser Resurfacing: Carbon Dioxide (Treatment)

are recommended to routinely prescribe the prophylactic use of an antiviral medication during the postoperative period, regardless of a patient's herpes simplex virus history. Some surgeons begin the regimen 24 h prior to surgery, while others initiate treatment on the morning of surgery. Commonly used regimens include famciclovir 250 mg PO bid, acyclovir 400 mg PO tid, and valacyclovir 500 mg PO bid for 7-10 d. Antibiotics Some surgeons routinely prescribe antibiotics for bacterial prophylaxis; however

2014 eMedicine.com

124. 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

125. 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

126. Chickenpox (Overview)

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

127. Esophagitis (Overview)

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

128. Cutaneous Laser Resurfacing: Erbium:YAG (Overview)

to reactivation of latent herpes simplex virus infection or predispose the patient to a primary infection during the reepithelialization phase of healing. It is recommended that prophylactic antiviral medication be prescribed during the postoperative period, regardless of a patient's herpes simplex virus history. Commonly used regimens include famciclovir 250 mg twice daily, acyclovir 400 mg 3 times a day, or valacyclovir 500 mg twice daily. The medication may be administered the day before, or morning

2014 eMedicine.com

129. Cutaneous Laser Resurfacing: Carbon Dioxide (Overview)

are recommended to routinely prescribe the prophylactic use of an antiviral medication during the postoperative period, regardless of a patient's herpes simplex virus history. Some surgeons begin the regimen 24 h prior to surgery, while others initiate treatment on the morning of surgery. Commonly used regimens include famciclovir 250 mg PO bid, acyclovir 400 mg PO tid, and valacyclovir 500 mg PO bid for 7-10 d. Antibiotics Some surgeons routinely prescribe antibiotics for bacterial prophylaxis; however

2014 eMedicine.com

130. Acute Retinal Necrosis (Treatment)

diagnosis hastens earlier antiviral therapy. Better initial visual acuity makes for better visual outcomes. [ ] Next: Medical Care Acute retinal necrosis (ARN) treatment consists of the following [ ] : Antiviral therapy, including intravenous acyclovir, oral valacyclovir, oral famciclovir, intravitreal foscarnet, intravitreal valacyclovir, or intravitreal famciclovir, [ , , , ] or a combination of oral and intravitreal antiviral therapies: Given the evidence that most cases of ARN are due to varicella

2014 eMedicine.com

131. 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

132. 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

133. 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

134. 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

135. 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

136. 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

137. 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

138. 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

139. 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

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