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Famciclovir

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162. Postherpetic Neuralgia (Overview)

for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA . 1998 Dec 2. 280(21):1837-42. . 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

2014 eMedicine.com

163. 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

164. 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

166. Herpes Zoster (Overview)

: 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

167. Herpes Simplex Encephalitis (Overview)

with antiviral therapy in the form of acyclovir. Start empiric acyclovir therapy promptly in patients with suspected HSE pending confirmation of the diagnosis, because acyclovir is relatively nontoxic and because the prognosis for untreated HSE is poor. Pharmacotherapy Medications used in the management of HSE include the following: Antivirals (eg, acyclovir, famciclovir): Drug of choice for HSE; to shorten the clinical course, prevent complications, prevent development of latency and subsequent recurrences

2014 eMedicine.com

168. Herpes Simplex (Overview)

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 infection increases HIV acquisition

2014 eMedicine.com

169. 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

171. Herpes Zoster (Overview)

: 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

172. Herpes Zoster (Overview)

: 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

173. Herpes Simplex (Overview)

of normal adults. Invest Ophthalmol Vis Sci . 2005 Jan. 46(1):241-7. . Amir J, Harel L, Smetana Z, Varsano I. Treatment of herpes simplex gingivostomatitis with aciclovir in children: a randomised double blind placebo controlled study. BMJ . 1997 Jun 21. 314 (7097):1800-3. . Spruance SL, Bodsworth N, Resnick H, Conant M, Oeuvray C, Gao J, et al. Single-dose, patient-initiated famciclovir: a randomized, double-blind, placebo-controlled trial for episodic treatment of herpes labialis. J Am Acad Dermatol (...) valacyclovir to reduce the risk of transmission of genital herpes. N Engl J Med . 2004 Jan 1. 350 (1):11-20. . Abudalu M, Tyring S, Koltun W, Bodsworth N, Hamed K. Single-day, patient-initiated famciclovir therapy versus 3-day valacyclovir regimen for recurrent genital herpes: a randomized, double-blind, comparative trial. Clin Infect Dis . 2008 Sep 1. 47 (5):651-8. . Levin MJ, Bacon TH, Leary JJ. Resistance of herpes simplex virus infections to nucleoside analogues in HIV-infected patients. Clin Infect

2014 eMedicine.com

174. Intravenous-to-Oral Switch Therapy (Overview)

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

175. 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

177. Varicella Zoster (Overview)

: 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

178. Varicella-Zoster Virus (Overview)

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

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