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Famciclovir

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141. 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

142. 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

143. 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

144. 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

145. 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

146. 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

147. 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

149. Intravenous-to-Oral Switch Therapy (Treatment)

IV divided q8h or 10 mg/kg/dose IV q8h for 7 d. Famciclovir and valacyclovir The bioavailability of acyclovir is approximately 8%. The bioavailability of and is approximately 50%. Now that famciclovir and valacyclovir have been approved, choosing either agent seems advisable when switching from intravenous acyclovir to an oral agent. Previous Next: Inpatient Care Inpatients with nonsevere community-acquired pneumonia (CAP) can be effectively and safely treated with oral antimicrobials from

2014 eMedicine.com

150. Viral Infections of the Mouth (Treatment)

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

151. Varicella-Zoster Virus (Treatment)

medications, including valacyclovir, penciclovir, and famciclovir, are also available. They may have an increasing role in the treatment of typical zoster. Studies suggest that, when compared with oral acyclovir, the new medications may decrease the duration of the patient's pain. Varicella zoster immune globulin (VariZIG) is indicated for administration to high-risk individuals within 10 days (ideally within 4 days) of chickenpox (varicella zoster virus) exposure. [ ] In July 2013, the CDC issued updated (...) in a tertiary dermatology outpatient referral clinic. Int J Dermatol . 1997 Sep. 36(9):667-72. . Goldman GS. Universal varicella vaccination: efficacy trends and effect on herpes zoster. Int J 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

2014 eMedicine.com

152. Varicella 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

153. Viral Infections and Pregnancy (Treatment)

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

154. 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

155. Polyarteritis Nodosa (Treatment)

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

156. Polyarteritis Nodosa (Treatment)

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

157. 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

158. 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

159. Upper Respiratory Tract Infection (Treatment)

for hospitalization is lowered for these patients, their risks of nosocomial infections must be weighed against the benefits of close monitoring in the inpatient setting. Although antivirals do not generally play a role in most cases of upper respiratory tract disease, consider available treatment options for HSV pharyngitis, respiratory syncytial virus (RSV) infection, and cytomegalovirus (CMV) infection in immunocompromised patients. HSV infection may be treated with acyclovir, famciclovir, or valacyclovir

2014 eMedicine.com

160. 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

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