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Famciclovir

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121. Herpes Zoster (Diagnosis)

: Acyclovir Famciclovir Valacyclovir Hospital admission should be considered for patients with any of the following: Severe symptoms Immunosuppression Atypical presentations (eg, myelitis) Involvement of more than 2 dermatomes Significant facial bacterial superinfection Disseminated herpes zoster Ophthalmic involvement Meningoencephalopathic involvement Prevention and treatment of postherpetic neuralgia Prompt treatment of acute zoster and its associated pain (eg, with antiviral therapy) can prevent (...) of dermatomal herpes zoster successfully treated with famciclovir and lactulose. J Am Acad Dermatol . 1998 Feb. 38(2 Pt 1):279-80. . Cresswell F, Eadie J, Longley N, Macallan D. Severe Guillain-Barré syndrome following primary infection with varicella zoster virus in an adult. Int J Infect Dis . 2010 Feb. 14(2):e161-3. . Shapiro JS. Does varicella-zoster virus infection of the peripheral ganglia cause Chronic Fatigue Syndrome?. Med Hypotheses . 2009 Nov. 73(5):728-34. . Moodley A, Swanson J, Grose C

2014 eMedicine.com

122. Herpes Zoster (Diagnosis)

: Acyclovir Famciclovir Valacyclovir Hospital admission should be considered for patients with any of the following: Severe symptoms Immunosuppression Atypical presentations (eg, myelitis) Involvement of more than 2 dermatomes Significant facial bacterial superinfection Disseminated herpes zoster Ophthalmic involvement Meningoencephalopathic involvement Prevention and treatment of postherpetic neuralgia Prompt treatment of acute zoster and its associated pain (eg, with antiviral therapy) can prevent (...) of dermatomal herpes zoster successfully treated with famciclovir and lactulose. J Am Acad Dermatol . 1998 Feb. 38(2 Pt 1):279-80. . Cresswell F, Eadie J, Longley N, Macallan D. Severe Guillain-Barré syndrome following primary infection with varicella zoster virus in an adult. Int J Infect Dis . 2010 Feb. 14(2):e161-3. . Shapiro JS. Does varicella-zoster virus infection of the peripheral ganglia cause Chronic Fatigue Syndrome?. Med Hypotheses . 2009 Nov. 73(5):728-34. . Moodley A, Swanson J, Grose C

2014 eMedicine.com

123. 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

124. Benign Cervical Lesions (Diagnosis)

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

125. Viral Infections of the Mouth (Diagnosis)

prophylactic antiviral medication may be indicated for patients who experience 6 or more recurrences a year or for patients who experience repeated bouts of erythema multiforme induced by herpes. [ ] Medical care for HHV-3 (varicella-zoster virus) Antiviral therapy is most effective in limiting the area of involvement and the duration of the symptoms if instituted within the first 48-72 hours. Acyclovir may control the size of the lesions, but it is less effective than valacyclovir or famciclovir

2014 eMedicine.com

126. Viral Infections and Pregnancy (Diagnosis)

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

127. Varicella-Zoster Virus (Diagnosis)

Treatment options are based on the following: Patient age Patient immune state Duration of symptoms Presentation Antiviral medications decrease the duration of symptoms and the likelihood of postherpetic neuralgia, especially when initiated within 2 days of the onset of rash. Oral acyclovir may be prescribed in otherwise healthy patients who have typical cases. Compared with oral acyclovir, other medications (eg, valacyclovir, penciclovir, famciclovir) may decrease the duration of the patient's pain (...) Toxicol . 2005 Jul-Aug. 24(4):205-13. . Hong JJ, Elgart ML. Gastrointestinal complications of dermatomal herpes zoster successfully treated with famciclovir and lactulose. J Am Acad Dermatol . 1998 Feb. 38(2 Pt 1):279-80. . Hovens MM, Vaessen N, Sijpkens YW, de Fijter JW. Unusual presentation of central nervous system manifestations of Varicella zoster virus vasculopathy in renal transplant recipients. Transpl Infect Dis . 2007 Sep. 9(3):237-40. . Liang MG, Heidelberg KA, Jacobson RM, McEvoy MT

2014 eMedicine.com

128. Varicella Zoster (Diagnosis)

: Acyclovir Famciclovir Valacyclovir Hospital admission should be considered for patients with any of the following: Severe symptoms Immunosuppression Atypical presentations (eg, myelitis) Involvement of more than 2 dermatomes Significant facial bacterial superinfection Disseminated herpes zoster Ophthalmic involvement Meningoencephalopathic involvement Prevention and treatment of postherpetic neuralgia Prompt treatment of acute zoster and its associated pain (eg, with antiviral therapy) can prevent (...) of dermatomal herpes zoster successfully treated with famciclovir and lactulose. J Am Acad Dermatol . 1998 Feb. 38(2 Pt 1):279-80. . Cresswell F, Eadie J, Longley N, Macallan D. Severe Guillain-Barré syndrome following primary infection with varicella zoster virus in an adult. Int J Infect Dis . 2010 Feb. 14(2):e161-3. . Shapiro JS. Does varicella-zoster virus infection of the peripheral ganglia cause Chronic Fatigue Syndrome?. Med Hypotheses . 2009 Nov. 73(5):728-34. . Moodley A, Swanson J, Grose C

2014 eMedicine.com

129. 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

130. 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

131. Postherpetic Neuralgia (Treatment)

. . 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. . Watson CP. Postherpetic neuralgia. Neurol Clin . 1989 May. 7(2):231-48

2014 eMedicine.com

133. 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

134. Chickenpox (Treatment)

symptoms and disease duration. Valacyclovir, the L-valyl ester of acyclovir, is a prodrug that has higher oral bioavailability than acyclovir. Valacyclovir is used in the treatment of herpes zoster, but no large-based clinical trials yet have demonstrated its efficacy in primary varicella infection of healthy, immunocompetent individuals. Famciclovir is a prodrug of penciclovir, which is a nucleoside analogue similar to acyclovir. Like valacyclovir, famciclovir has demonstrated efficacy

2014 eMedicine.com

135. 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

136. 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

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 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

139. 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

140. 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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