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Famciclovir

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141. 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

142. Conjunctivitis, Viral (Treatment)

. Valacyclovir 1000 mg or famciclovir 500 mg PO TID for 7-10 days is also approved for herpes zoster infection. Topical corticosteroids usually are not indicated for conjunctivitis or keratitis. Molluscum contagiosum For conjunctivitis associated with molluscum contagiosum, disease will persist until the skin lesion is treated. Removal of the central core of the lesion or inducement of bleeding within the lesion usually is enough to cure the infection. Occasionally, surgical excision is required

2014 eMedicine.com

143. 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

144. 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

145. 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

146. 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

148. 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

149. 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

150. 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

151. 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

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. Polyarteritis Nodosa (Overview)

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 in an individual with periarteritis nodosa. Hepatogastroenterology . 1999 Jul-Aug. 46(28):2529-31. . de Menthon M

2014 eMedicine.com

154. Polyarteritis Nodosa (Overview)

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 in an individual with periarteritis nodosa. Hepatogastroenterology . 1999 Jul-Aug. 46(28):2529-31. . de Menthon M

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. Gynecologic Pain (Overview)

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

159. Genital Herpes in Pregnancy (Overview)

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

160. Benign Cervical Lesions (Overview)

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

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