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Famciclovir

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161. 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

162. 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

163. 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

164. 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

165. 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

166. 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

167. 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

168. 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

169. 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

170. 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 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

174. Laser-Assisted Hair Removal (Overview)

, the area must not be irritated. If the patient is uncomfortable with the idea of shaving the area, a depilatory cream can be used instead. Antivirals: The patient should start prophylactic antiviral medications (eg, acyclovir, valacyclovir, famciclovir) when indicated. Antibiotics: The patient should start oral antibiotics when indicated (eg, nasal, perianal skin). Day of treatment and technique Day of treatment concerns are as follows: Cleansing and makeup: The area to be treated should be clean

2014 eMedicine.com

175. 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

176. Viral Infections of the Mouth (Overview)

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

177. Viral Infections and Pregnancy (Overview)

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

179. 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

180. 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

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