acyclovir and Pain

Every year I see preschool children with gingivostomatitis. There seems to be quite a substantial burden of illness with this condition. Because it is caused by herpes simplex virus type 1, should I prescribe antiherpetic therapy with oral acyclovir?. While most children with primary gingivostomatitis will be asymptomatic, some will experience considerable pain and discomfort and are at risk of dehydration. There are no large, well designed studies to clearly determine appropriate therapy for all children. Based on a single randomized study, treatment should be started only within the first 72 hours of symptom onset if substantial pain or dehydration are documented.

Topics: Acyclovir; Antiviral Agents; Child; Dehydration; Humans; Pain; Pediatrics; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Stomatitis, Herpetic

Topics: Acyclovir; Antiviral Agents; Drug Administration Routes; Herpes Genitalis; Humans; Pain; Pain Management; Pain Measurement; Randomized Controlled Trials as Topic; Time Factors; Treatment Outcome

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Administration, Oral; Adult; Age Factors; Analgesics, Non-Narcotic; Analgesics, Opioid; Anticonvulsants; Antidepressive Agents, Tricyclic; Antiviral Agents; Bromodeoxyuridine; Child; Drug Therapy, Combination; Famciclovir; Female; Herpes Zoster; Herpesvirus 3, Human; Herpesvirus Vaccines; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain; Prodrugs; Risk Factors; Sex Factors; Time Factors; Vaccination; Valacyclovir; Valine

Topics: Acetates; Acyclovir; Age Factors; Aged; Aged, 80 and over; Amines; Analgesics; Antiviral Agents; Cyclohexanecarboxylic Acids; Diagnosis, Differential; Earache; Fever; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Male; Oxycodone; Pain; Patient Selection; Polymerase Chain Reaction; Risk Factors; Valacyclovir; Valine

Herpetic gingivostomatitis (HGS) is the predominant manifestation of cutaneomucosal herpes in children with HSV1 primary infection before the age of 3 years. The infection is self limiting and lasts 10 to 14 days. Pain and dysphagia are particularly important during the first week of infection and may necessitate parenteral rehydratation and administration of antalgesics. HGS in the young child causes substantial morbidity leading to hospital and social costs (work stoppage for parents). The clinical course is generally benign with the exception of forms with important extension, eczema, herpeticum Kaposi-Juliusberg pustulosis observed at this age only in children with atopic dermititis. Other severe forms are observed in the neonate and immunodepressed subject, which can also be caused by HSV1. Forms with little or not clinical manifestation predominate and generally go undiagnosed, explaining the asymptomatic viral excretion observed in the saliva or other secretions (ocular, genital secretions). Despite the sterotypic nature of the clinical expression, HGS is still often undiagnosed both by general practitioners and pediatricians. This lack of diagnosis generally has few consequences due to the benign course in a few days, but the infection can have an important psychological and social leading to significant healthcare costs. Moderate and severe forms require medical care. Aciclovir should be prescribed if the diagnosis is made early (3 days) in combination with symptomatic care. Studies of the medical and economic impact of herpetic gingivostomatis should be conducted.

Topics: Acyclovir; Antiviral Agents; Child, Preschool; Costs and Cost Analysis; Deglutition Disorders; Herpesvirus 1, Human; Humans; Pain; Physical Examination; Stomatitis, Herpetic

After herpes zoster, immunocompetent persons frequently experience chronic pain and considerable suffering. Zoster-associated pain has a complex pathophysiology that begins with viral damage and increased sensitization of peripheral sensory neurons. The enhanced afferent barrage from these neurons sensitizes spinal neurons and leads to loss of synapses from descending inhibitory fibers, resulting in central neuropathic pain and allodynia. Antiviral therapy of acute zoster limits this sequence of pathophysiologic mechanisms. There is no clear consensus regarding the optimal means of determining the benefits of antiviral therapy in the management of pain of herpes zoster. A novel statistical approach utilizing rates of disappearance of pain of differing pathophysiologic mechanisms is proposed.

Topics: 2-Aminopurine; Acyclovir; Analgesics; Antiviral Agents; Chronic Disease; Clinical Trials as Topic; Famciclovir; Herpes Zoster; Herpesvirus 3, Human; Humans; Meta-Analysis as Topic; Pain; Pain Measurement; Proportional Hazards Models; Treatment Outcome; Valacyclovir; Valine

The past several years have provided exciting advances in the management of herpes zoster in the normal host. In spite of these advances, a significant portion of zoster patients still have persistent complications from this disease. Persistent pain is the most debilitating sequela and it occurs in at least 15% of individuals over 50 years of age. Future research efforts must embrace alternative approaches for pain control.

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Herpes Zoster; Humans; Pain; Prednisone; Prodrugs; Valacyclovir; Valine

A 43-year-old woman was admitted with a 14-day history of general malaise, subfebrile temperature, radicular dysaesthesias in the "riding breeches" area, severe pain in the lumbar region and progressive disorders of bladder and rectal emptying. Physical examination showed a conus-cauda syndrome. Differential diagnosis was between myelitis (inflammatory or infectious), space-occupying intraspinal mass or vascular lesion.. Cerebrospinal fluid contained 1700/3 cells and there was intrathecal antibody synthesis against varicella zoster virus (VZV) and positive VZV-DNA analysis in the polymerase chain reaction. Magnetic resonance imaging of the lumbar spine revealed an inflamed enlarged conal and epiconal area with small haemorrhagic spots. There was no evidence of an underlying immune-modulated disease.. With the diagnosis of varicella zoster myelitis with cutaneous changes having been established the clinical signs and symptoms regressed almost completely with aciclovir administration (10mg/kg intravenously for 14 days).. VZV without cutaneous involvement should be considered in the differential diagnosis of the radicular pain syndrome. When clinical signs of beginning myelitis or encephalitis are present, immediate investigations and therapy are necessary.

Topics: Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Female; Hemorrhoids; Herpes Zoster; Humans; Myelitis; Pain; Remission Induction; Sacrococcygeal Region; Spinal Nerve Roots; Syndrome

The natural history of herpes zoster ophthalmicus and aspects of its treatment and prevention are presented. Intraocular complications occur in 50 percent of cases. Anterior uveitis and the various varieties of keratitis are commonest, affecting 92% and 52% of patients with ocular involvement, respectively. Sight-threatening complications include neuropathic keratitis, perforation, secondary glaucoma, posterior scleritis/orbital apex syndrome, optic neuritis, and acute retinal necrosis. Twenty-eight percent of initially involved eyes develop long-term ocular disease (6 months), with chronic uveitis, keratitis, and neuropathic ulceration being the commonest. Acute pain occurs in 93% of patients and is still present in 31% at 6 months. Of patients aged 60 and over pain persists in 30% for 6 months or longer, and this rises to 71% in those aged 80 and over. Current evidence favours the use of topical acyclovir alone for treatment of established ocular complications, with topical steroids being withheld in all but the most severe cases. Stellate ganglion block has proved useful in the treatment of established acute pain. Amitryptiline, and to a lesser extent sodium valproate, are useful in established chronic pain. Evidence of the efficacy of early oral acyclovir on ocular complications is conflicting, with two studies reporting significant improvement in differing disease parameters. A similar situation exists for pain, with published studies showing differing effects on pain at varying times after the onset of disease. The use of systemic steroids to prevent pain is not supported by currently available evidence, but its therapeutic relationship with acyclovir requires further evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acyclovir; Aged; Aged, 80 and over; Herpes Zoster Ophthalmicus; Humans; Middle Aged; Pain

An overview of all the available placebo-controlled trial data for oral acyclovir in acute herpes zoster infection has confirmed that a dose of 800 mg five times daily for seven to ten days is effective in reducing the incidence of post-herpetic neuralgia and the duration of pain. Although one study failed to demonstrate such an effect, three other studies and a combined analysis, using the log rank test, did so. The duration of pain was shortened from an average of 86 to 49 days (p less than 0.001). Future studies will need to take account of these findings since oral acyclovir is most likely to be used as the standard reference therapy.

Topics: Acute Disease; Acyclovir; Herpes Zoster; Herpes Zoster Oticus; Humans; Pain; Randomized Controlled Trials as Topic

Topics: Acyclovir; Antiviral Agents; Carbamazepine; Herpes Zoster; Humans; Pain

Acyclovir given intravenously in either low dose (5 mg/kg every 8 h) or high dose (500 mg/m2 every 8 h) significantly reduced pain and accelerated skin healing in acute herpes zoster occurring in otherwise healthy adults. The higher dose also significantly reduced the duration of viral shedding. No significant effect on post-herpetic neuralgia could be demonstrated, although the higher dose showed a promising trend. No adverse effects were associated with the lower dose, but acyclovir at 500 mg/m2 resulted in nausea, vomiting and transiently elevated serum creatinine in a substantial number of patients.

Topics: Acyclovir; Adult; Creatinine; Follow-Up Studies; Herpes Zoster; Humans; Injections, Intravenous; Nausea; Pain; Random Allocation; Time Factors; Vomiting

Lesions of herpes labialis are caused by the herpes simplex virus type 1 and cause pain and aesthetic compromise. It is characterized by the formation of small vesicles that coalesce and rupture forming extremely painful ulcers, that evolve to crusts, dry desquamations until their complete remission. Currently the treatment of these lesions is done with acyclovir. Although it diminishes the symptomatology, it causes viral resistance and does not prevent the recurrence of the lesions. It is known that antimicrobial photodynamic therapy (aPDT) has numerous advantages, among them: the reduction of the time of remission, and does not cause resistance. This protocol will determine the effectiveness of PDT in lesions of herpes labialis.. A total of 30 patients with herpes labialis in the prodromal stage of vesicles, ulcers, and crusts will be selected to participate in the study and randomized into 2 groups: G1 control and G2 experimental. After signing Research Ethics Committee and TA, patients in group G1 will undergo the standard gold treatment for herpes labialis with acyclovir and simulated PDT treatment. Patients in the experimental G2 group will be treated simulating the gold standard treatment of herpes labialis (placebo) and PDT. In all patients, saliva samples will be collected for analysis of cytokines, and will be performed exfoliative cytology in the lesions. The pain will be assessed through a pain scale and a questionnaire of quality of life related to oral health (OHIP-14) will be given to them. Patients will continue to be followed up after 7 days, 1 month, 3 months, and 6 months; if there is a recurrence of the lesion, they will contact the researchers.Clinical registration: clinicaltrials.gov - NCT04037475. Registered on July 2019.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Labialis; Herpesvirus 1, Human; Humans; Male; Pain; Photochemotherapy; Prospective Studies; Quality of Life; Recurrence; Ulcer; Visual Analog Scale; Young Adult

This study investigated the safety and efficacy of famciclovir compared to acyclovir in patients with herpes zoster, to determine whether the two regimens are equally effective for the treatment of patients with uncomplicated herpes zoster over a period of 7days.. Patients were randomly assigned to receive either famciclovir 500mg (one tablet) three times daily or acyclovir 800mg (two capsules) five times daily for 7 days. The primary endpoint was defined as the time to full crusting of herpes zoster lesions. Secondary endpoints were the proportion of patients who achieved complete cure and the change in score of signs/symptoms (pain, vesicular lesions, loss of sensitivity, burning pain, and pruritus) according to the patient diary. This study has been registered at ClinicalTrials.gov (NCT01327144).. One hundred and seventy-four patients were enrolled and randomized; 151 of these patients completed treatment (n=75 famciclovir, n=76 acyclovir). A similar proportion of patients who received acyclovir (94.74%) and famciclovir (94.67%) achieved complete cure. The mean time to full crusting of herpes zoster lesions was 15.033days in the acyclovir group and 14.840days in the famciclovir group (log-rank p-value=0.820). The most common adverse events in the pooled groups were headache, diarrhea, nausea, back pain, cold, and drowsiness, but none of these was deemed to be clinically important.. Both interventions obtained high rates of cure and had a similar time to full crusting of lesions. Analysis of the primary efficacy endpoint proved that famciclovir is non-inferior to acyclovir, as the confidence interval for the difference in efficacy did not violate the non-inferior margin. Therefore, the results are not different enough to be clinically relevant.

Topics: 2-Aminopurine; Acyclovir; Adult; Aged; Antiviral Agents; Famciclovir; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Pain; Pruritus; Treatment Outcome

Worldwide, about 90% of people are infected with the herpes simplex virus, 30% of whom will experience recurrent herpes simplex labialis, commonly referred to as 'cold sores', which can last up to 10 days. The most common treatment is aciclovir cream which reduces healing time by just half a day compared with no specific treatment. This is a protocol for a randomised controlled trial (RCT) to determine the efficacy of medical grade kanuka honey-based topical treatment (Honevo) in reducing the healing time and pain of cold sores, compared with topical aciclovir treatment (Viraban).. This open-label, parallel-group, active comparator superiority RCT will compare the efficacy of medical grade kanuka honey with 5% aciclovir cream in the treatment of cold sores in the setting of a pharmacy research network of 60 sites throughout New Zealand. Adults presenting with a cold sore (N=950) will be randomised by pharmacy-based investigators. The pharmacy-based investigators will dispense the investigational product to randomised participants and both study groups apply the treatment five times daily until their skin returns to normal or for 14 days, whichever occurs first. In response to a daily SMS message, participants complete an assessment of their cold sore healing, with reference to a visual guide, and transmit it to the investigators by a smartphone eDiary in real time. The primary outcome variable is time (in days) from randomisation to return to normal skin. Secondary endpoints include total healing time stratified by stage of the lesion at onset of treatment, highest pain severity and time to pain resolution.. New Zealand Ethics Registration 15/NTB/93. Results will be published in a peer-reviewed medical journal, presented at academic meetings and reported to participants.. Australia New Zealand Clinical Trials Registry: ACTRN12615000648527, pre-results.SCOTT Registration: 15/SCOTT/14 PROTOCOL VERSION: 4.0 (12 June 2017).

Topics: Acyclovir; Administration, Topical; Adolescent; Adult; Aged; Antiviral Agents; Apitherapy; Herpes Labialis; Herpes Simplex; Honey; Humans; Kunzea; Middle Aged; New Zealand; Pain; Recurrence; Research Design; Simplexvirus; Skin; Treatment Outcome

This prospective, parallel-group, randomized, double-blind, multicenter study compared the efficacy and safety of FV-100 with valacyclovir for reducing pain associated with acute herpes zoster (HZ). Patients, ≥50 years of age, diagnosed with HZ within 72 h of lesion appearance who had HZ-associated pain, were randomized 1:1:1 to a 7-day course of either FV-100 200 mg QD (n = 117), FV-100 400 mg QD (n = 116), or valacyclovir 1000 mg TID (n =117). Efficacy was evaluated on the basis of the burden of illness (BOI; Zoster Brief Pain Inventory scores); incidence and duration of clinically significant pain (CSP); pain scores; incidence and severity of post-herpetic neuralgia (PHN); and times to full lesion crusting and to lesion healing. Safety was evaluated on the basis of adverse event (AE)/SAE profiles, changes in laboratory and vital signs values, and results of electrocardiograms. The burden of illness scores for pain through 30 days were 114.5, 110.3, and 118.0 for FV-100 200 mg, FV-100 400 mg, and valacyclovir 3000 mg, respectively. The incidences of PHN at 90 days for FV-100 200 mg, FV-100 400 mg, and valacyclovir 3000 mg were 17.8%, 12.4%, and 20.2%, respectively. Adverse event and SAE profiles of the two FV-100 and the valacyclovir groups were similar and no untoward signals or trends were evident. These results demonstrate a potential for FV-100 as an antiviral for the treatment of shingles that could both reduce the pain burden of the acute episode and reduce the incidence of PHN compared with available treatments.

Topics: Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Cost of Illness; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain; Pain Management; Prospective Studies; Pyrimidine Nucleosides; Valacyclovir; Valine

Alternative treatment for recurrent labial infection by herpes simplex virus (HSV) have been considered. The aim of this study was to evaluate the effectiveness of laser phototherapy in prevention and reduction of severity of labial manifestations of herpes labialis virus. Seventy-one patients, divided into experimental (n = 41) and control (n = 30) groups were followed up for 16 months. Patients in the control group were treated topically with aciclovir and patients in the experimental group were subjected to laser phototherapy (one session per week, 10 weeks): 780 nm, 60 mW, 3.0 J/cm(2) or 4.5 J/cm(2) on healthy (no HSV-1 infection) and affected (with HSV-1 infection) tissues. Patients in the experimental group presented a significant decrease in dimension of herpes labialis lesions (P = 0.013) and inflammatory edema (P = 0.031). The reduction in pain level (P = 0.051) and monthly recurrences (P = 0.076) did not reach statistical significance. This study represents an in vivo indication that this treatment should be further considered as an effective alternative to therapeutic regimens for herpes labialis lesions.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Labialis; Humans; Low-Level Light Therapy; Male; Pain; Secondary Prevention

Various treatments have been used to manage post-herpetic neuralgia (PHN). Safe and effective therapies to prevent PHN are needed.. A clinical trial involving 152 patients diagnosed with acute herpes Zoster (HZ) was conducted to determine whether short-course acyclovir therapy (800 mg five times a day for four days) can alleviate HZ-associated pain and prevent post-herpetic neuralgia (PHN).  The patients were divided into two groups: Group 1 had a rash with a duration of less than 72 hours and Group 2 had a rash with a duration of more than 72 hours. To assess PHN, the patients categorized and assessed the severity of their symptoms using a four-point verbal rating scale (VRS).. By the fourth week, 134 out of 152 patients (88.2%) had complete pain response (CPR). Of these, 68 patients (89.5%) were from Group 1 and 66 from Group 2 (86.8%). After four weeks, the mean VRS scores had changed significantly in both groups compared to the scores at the beginning of study (p = 0.001), but there was no difference between the two groups (0.88 ± 0.66 Vs. 0.94 ± 0.72; p = 0.66) After three months no differences were observed in the treatment results between the two groups (0.51 ± 0.13 Vs.0.54 ± 0.19; p = 0.77).. Short-course acyclovir therapy is an effective treatment for zoster and its efficacy in patients with a rash duration of more than 72 hours is similar to that in patients with rash duration of less than 72 hours.

Topics: Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Drug Administration Schedule; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain; Time Factors; Treatment Outcome

To evaluate the effect of prednisolone and valacyclovir on ipsilateral pain around the ear and in the face or neck in Bell's palsy. The incidence and intensity of pain during the first 2 months of palsy and its prognostic value were also assessed.. Prospective, randomized, double-blind, placebo-controlled, multicenter trial.. Sixteen tertiary referral centers in Sweden and 1 in Finland.. Data are part of the Scandinavian Bell's palsy study; 829 patients aged 18 to 75 years with onset of palsy within 72 hours were included. Follow-up time was 12 months.. Patients were assigned to 1 of 4 treatment arms in a factorial fashion: placebo plus placebo; prednisolone 60 mg daily for 5 days, then tapering for 5 days, plus placebo; valacyclovir 1,000 mg 3 times daily for 7 days plus placebo; or prednisolone plus valacyclovir.. Pain was registered on a visual analog scale within 72 hours, at Days 11 to 17, 1 month, and 2 months. Facial function was assessed with the Sunnybrook and House-Brackmann systems.. Prednisolone and/or valacyclovir did not significantly affect the incidence or intensity of pain during the first 2 months. Pain was registered in 542 (65%) of 829 patients. At 2 months, 53 (8%) of 637 patients still reported pain. Subjects with pain at Days 11 to 17 had lower facial recovery rates at 12 months than those with no pain (p < 0.0001).. Prednisolone and/or valacyclovir did not affect the incidence or intensity of ipsilateral pain in Bell's palsy. The incidence of pain was similar during the first 2 weeks and then decreased. Presence of pain at Days 11 to 17 indicated a worse prognosis for facial recovery.

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Double-Blind Method; Earache; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Neck Pain; Pain; Pain Measurement; Prednisolone; Prognosis; Prospective Studies; Treatment Outcome; Valacyclovir; Valine

To compare silica gel with acyclovir cream in the treatment of recurrent herpes labialis.. In this randomized, open-label, comparator-controlled trial, 74 patients with recurrent herpes labialis applied silica gel or acyclovir cream respectively over a period of 10 days. The treatment started within 24 hours of the first symptoms of a new recurrence. Patients rated five symptoms (tautness, tingling, itching, burning sensation, pain), lesion stage, efficacy, tolerability, and duration until the onset of improvement. Their willingness-to-pay was assessed. Physicians rated the severity of the herpes recurrence and efficacy.. There was no significant difference between silica gel and acyclovir cream in the overall patients' assessment. There is evidence that silica gel relieved all investigated symptoms earlier than acyclovir cream. The efficacy and tolerability of both medications were rated as good to very good.. Silica gel was as effective in the treatment of recurrent herpes labialis as acyclovir and equally well tolerated and tended to take effect more quickly. Therefore, silica gel could prove a useful alternative to topical acyclovir.

Topics: Acyclovir; Administration, Topical; Adult; Antiviral Agents; Dermatologic Agents; Female; Gels; Herpes Labialis; Humans; Lip; Male; Middle Aged; Pain; Patient Satisfaction; Pruritus; Severity of Illness Index; Silica Gel; Silicon Dioxide; Treatment Outcome

Corticosteroids and antiviral agents are widely used to treat the early stages of idiopathic facial paralysis (i.e., Bell's palsy), but their effectiveness is uncertain.. We conducted a double-blind, placebo-controlled, randomized, factorial trial involving patients with Bell's palsy who were recruited within 72 hours after the onset of symptoms. Patients were randomly assigned to receive 10 days of treatment with prednisolone, acyclovir, both agents, or placebo. The primary outcome was recovery of facial function, as rated on the House-Brackmann scale. Secondary outcomes included quality of life, appearance, and pain.. Final outcomes were assessed for 496 of 551 patients who underwent randomization. At 3 months, the proportions of patients who had recovered facial function were 83.0% in the prednisolone group as compared with 63.6% among patients who did not receive prednisolone (P<0.001) and 71.2% in the acyclovir group as compared with 75.7% among patients who did not receive acyclovir (adjusted P=0.50). After 9 months, these proportions were 94.4% for prednisolone and 81.6% for no prednisolone (P<0.001) and 85.4% for acyclovir and 90.8% for no acyclovir (adjusted P=0.10). For patients treated with both drugs, the proportions were 79.7% at 3 months (P<0.001) and 92.7% at 9 months (P<0.001). There were no clinically significant differences between the treatment groups in secondary outcomes. There were no serious adverse events in any group.. In patients with Bell's palsy, early treatment with prednisolone significantly improves the chances of complete recovery at 3 and 9 months. There is no evidence of a benefit of acyclovir given alone or an additional benefit of acyclovir in combination with prednisolone. (Current Controlled Trials number, ISRCTN71548196 [controlled-trials.com].).

Topics: Acyclovir; Adult; Antiviral Agents; Bell Palsy; Double-Blind Method; Drug Therapy, Combination; Facial Nerve; Factor Analysis, Statistical; Female; Glucocorticoids; Humans; Male; Middle Aged; Pain; Prednisolone; Quality of Life; Treatment Outcome

Famciclovir, the well absorbed oral pro-drug of penciclovir, is effective in the treatment of herpes zoster when given three times daily. Because the intracellular half-life of penciclovir triphosphate in varicella-zoster virus (VZV)-infected cells (7h) is considerably longer than that of aciclovir triphosphate (1h), it may be possible to administer famciclovir less frequently than three times daily for herpes zoster: aciclovir is administered five times daily.. 559 immunocompetent adults presenting with herpes zoster whose skin lesions were present for less than 72 h were randomized to receive famciclovir 750 mg once daily (od), 500 mg twice daily (bid), or 250 mg three times daily (tid), or aciclovir 800 mg five times daily. All treatments were given for 7 days. Participants were evaluated until complete healing or for 4 weeks, whichever occurred first.. There were no significant differences between the four treatment groups with respect to times to full crusting; loss of vesicles, ulcers and crusts; cessation of new lesion formation; a 50% reduction in the area of affected skin; and the loss of acute pain.. Famciclovir 750 mg once daily, 500 mg twice daily and 250 mg daily, and aciclovir 800 mg five times daily are three times comparable in efficacy with respect to the cutaneous healing of herpes zoster. The current study was not designed to assess the effects of the treatments on postherpetic neuralgia (PHN).

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Antiviral Agents; Double-Blind Method; Famciclovir; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Pain; Skin

To investigate the effect of an antiviral compound, valacyclovir, on pain and tenderness in patients with the fibromyalgia (FM) syndrome.. Sixty patients were randomized into a double blind, placebo controlled 6 week trial. Primary outcome was pain intensity change (on visual analog scale). Secondary outcome measures were tender points (myalgic score) and Fibromyalgia Impact Questionnaire (FIQ).. Fifty-two patients completed the study. The numbers of dropouts due to adverse events were equal in valacyclovir (2) and placebo (2) groups. The effect of valacyclovir on pain and tenderness and FIQ did not differ from placebo.. Valacyclovir cannot be recommended as a therapy for FM at this point.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Double-Blind Method; Female; Fibromyalgia; Humans; Joints; Male; Middle Aged; Pain; Pain Measurement; Sickness Impact Profile; Tablets; Valacyclovir; Valine

Oral valacyclovir is better absorbed than oral acyclovir, increasing acyclovir bioavailability three- to fivefold. This provides the opportunity to explore whether high systemic acyclovir concentrations are effective in the treatment of cold sores (herpes labialis). Two randomized, double-blind, placebo-controlled studies were conducted. Subjects were provided with 2 g of valacyclovir twice daily for 1 day (1-day treatment), 2 g of valacyclovir twice daily for 1 day and then 1 g of valacyclovir twice daily for 1 day (2-day treatment), or a matching placebo and instructed to initiate treatment upon the first symptoms of a cold sore. In study 1, the median duration of the episode (primary endpoint) was reduced by 1.0 day (P = 0.001) with 1-day treatment and 0.5 days (P = 0.009) with 2-day treatment compared to placebo. Similarly, the mean duration of the episode was statistically significantly reduced by 1.1 days with 1-day treatment and 0.7 days with 2-day treatment compared to placebo. The proportion of subjects in whom cold sore lesion development was prevented and/or blocked was increased by 6.4% (P = 0.096) with 1-day treatment and 8.5% (P = 0.061) with 2-day treatment compared to placebo. The time to lesion healing and time to cessation of pain and/or discomfort were statistically significantly reduced with valacyclovir compared to placebo. In study 2, results similar to those in study 1 were obtained. AEs were similar across treatment groups. These studies provide evidence supporting a simple, 1-day valacyclovir treatment regimen for cold sores that is safe and effective. The 1-day valacyclovir regimen offers patients a unique and convenient dosing alternative compared to available topical therapies.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Child; Double-Blind Method; Female; Herpes Labialis; Humans; Male; Middle Aged; Pain; Valacyclovir; Valine

Brivudin [(E)-5-(2-bromovinyl)-2'-deoxyuridine] is a nucleoside analogue with a high and selective antiviral activity against varicella-zoster virus (VZV) and herpes simplex virus type 1 (HSV-1). The double-blind, randomized study presented here compared efficacy and safety of oral brivudin 1 x 125 mg and acyclovir 5 x 800 mg, both for 7 days, in 1227 immunocompetent patients with herpes zoster. Main results were as follows: brivudin was superior to acyclovir in accelerating the "time to last formation of new vesicles" (primary parameter; risk ratio(ITT): 1.13, P=0.014). Equivalent effects of brivudin and acyclovir were observed for the secondary parameters "time to first crust" (RR(ITT): 0.93, P=0.004), "time to full crusting" (risk ratio(ITT): 1.03, P<0.001), and "time to loss of crusts" (RR(ITT): 0.95, P=0.002). The incidence of potentially treatment-related adverse events was similar under brivudin (7.7%) and acyclovir (10.0%). In conclusion, brivudin proved to be more effective than acyclovir in terminating vesicle formation, the parameter which reflects the end of viral replication, thus confirming, in the clinical setting, the greater in vitro antiviral activity of brivudin. Compared with acyclovir, brivudin provides a similar safety profile and a significant improvement in efficacy.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Bromodeoxyuridine; Double-Blind Method; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompetence; Male; Middle Aged; Pain; Skin; Virus Replication

Topics: 2-Aminopurine; Acyclovir; Aged; Antiviral Agents; Double-Blind Method; Famciclovir; Gastrointestinal Diseases; Headache; Herpes Zoster; Humans; Middle Aged; Nausea; Neuralgia; Pain; Prospective Studies; Time Factors; Treatment Outcome; Valacyclovir; Valine

To know the therapeutic efficiency in the genital herpes of two drugs: acyclovir and valaciclovir.. There were included in the study 142 patients with diagnostic of clinic first episode by genital herpes in two equal groups of 71 patients each one. The distribution in both groups was random to receive one of the following treatment standards: acyclovir 200 mg by verbal each 5 hours, during 7 days; valaciclovir: 500 mg by verbal each 12 hours during 7 days being valued objective and subjective response to the treatment.. The prevailing symptom was the pain (45% and 46.4%), followed by the warmth or burning sensation. The most frequent lesions in both groups were blisters (39.4% and 46.4%). The analysis response to the treatment in relationship to the symptoms as well as in the lesions it could be appreciated that there are not significant differences in the patients treated in both groups (p = 0.3). The adverse effect communicated by the discussed patients were scarce and similar in both groups.. Both drugs are suitable for the treatment of the genital herpes. The advantage observed with the valaciclovir is the dosing comfort and the facility of completing the treatment.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Antiviral Agents; Drug Administration Schedule; Female; Herpes Genitalis; Humans; Pain; Paresthesia; Patient Acceptance of Health Care; Treatment Outcome; Valacyclovir; Valine

In this randomized, double-blind, multicenter, acyclovir-controlled study, the efficacy and safety of famciclovir were evaluated for the treatment of herpes zoster in patients who were immunocompromised following bone marrow or solid organ transplantation or oncology treatment. A total of 148 patients, 12 years or older with clinical evidence of localized herpes zoster, received either oral famciclovir, 500 mg three times daily, or acyclovir, 800 mg five times daily, for 10 days. Famciclovir was equivalent to acyclovir with respect to the numbers of patients reporting new lesion formation while on therapy (77% vs. 73%, respectively). There were no significant differences between the groups in the time to cessation of new lesion formation, full crusting, complete healing of lesions, or loss of acute phase pain. Treatment with famciclovir was well tolerated, with a safety profile comparable to that of acyclovir. Thus oral famciclovir is a convenient, effective, and well-tolerated regimen for immunocompromised patients with herpes zoster.

Topics: 2-Aminopurine; Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Double-Blind Method; Famciclovir; Herpes Zoster; Humans; Immunocompromised Host; Male; Middle Aged; Pain; Skin Diseases

Reactivation of varicella zoster virus (VZV) is a common event in patients undergoing allogeneic bone marrow transplantation (BMT) and may lead to life-threatening complications. We retrospectively analyzed the incidence, clinical outcome, and risk factors for VZV infections occurring within the first 5 years of transplantation in 100 consecutive adults undergoing allogeneic BMT between 1992 and 1997. Forty-one patients (41%) developed VZV reactivation a median of 227 days (range 45-346 days) post-transplantation. Twelve percent of VZV reactivation occurred in the first 100 days and 88% within the first 24 months. Among those who survived for 2 or more years after transplantation (n = 47), 59% developed VZV infection. Forty percent of patients with VZV reactivation required admission with a mean hospital stay of 7.2 days. Two patients developed encephalitis, and 1 died despite antiviral therapy. The most frequent complications were post-herpetic neuralgia and peripheral neuropathy (68%). Thoracic dermatomal zoster represented 41% of the infections; disseminated cutaneous involvement was observed in 17% of patients. No clinical or epidemiologic risk factors were associated with recurrence. Administration of ganciclovir for prevention of cytomegalovirus infection delayed the onset of VZV infection beyond 4 months (P = .06). In a further subset analysis, patients with a limited chronic graft-versus-host disease (GVHD) had a lower estimated incidence of VZV reactivation compared with those with extensive chronic GVHD (P = .11). We conclude that complications from reactivation of VZV infection are common and associated with considerable morbidity and mortality in patients undergoing allogeneic BMT.

Topics: 2-Aminopurine; Acyclovir; Adolescent; Adult; Antiviral Agents; Bone Marrow Transplantation; Chickenpox; Cytomegalovirus Infections; Famciclovir; Female; Graft vs Host Disease; Herpes Zoster; Herpesvirus 3, Human; Humans; Incidence; Male; Middle Aged; Pain; Retrospective Studies; Risk Factors; Skin Diseases; Transplantation, Homologous; Treatment Outcome; Virus Activation

An observational study with valaciclovir was conducted to assess clinical outcome in herpes zoster, especially pain and associated neurological signs and symptoms in relation to a series of demographic and disease characteristics discernible at presentation. The safety and acceptability of valaciclovir for treatment of zoster was assessed in a wide variety of primary care and clinic referral settings.. In total, 1897 immunocompetent adults with clinically diagnosed, localized acute herpes zoster were enrolled in this international, open-label study of valaciclovir. All subjects received treatment with oral valaciclovir (1000 mg three times daily) for 7 days from entry to the study and were asked to record the presence of zoster-associated pain and abnormal sensations throughout treatment and 6 months' follow-up. They were seen frequently in clinic to verify subjective assessments and for evaluation of rash healing. Safety and tolerability were assessed by adverse event monitoring.. Overall, 1191 subjects (63%) were aged > or = 50 years, and 203 (11%) had ophthalmic zoster. Cessation of zoster-associated pain was significantly faster in the younger age group; median times to loss of zoster-associated pain were 23 days and 9 days in the > or = 50 and < 50 years age groups, respectively. Similarly, abnormal sensations resolved significantly more rapidly in the younger subjects; the median duration of abnormal sensations was 31 days in the > or = 50 year olds and 16 days in those aged < 50 years. In cases of ophthalmic zoster, the rate of pain resolution was not different from those with zoster in other dermatomes (median duration of pain 18 vs. 16 days). However, abnormal sensations persisted significantly longer in subjects with ophthalmic zoster than in those with zoster at other sites (47 vs. 22 days). In addition to advancing age, subjects suffering moderate to severe prodromal pain or acute pain during the rash phase were at significantly greater risk of zoster-associated pain and abnormal sensations persisting for longer. Subjects with concomitant neurological disorders were also more likely to develop prolonged abnormal sensations. Valaciclovir treatment was well tolerated, and adverse events were rare and generally mild.. This study confirmed the prognostic importance of advancing age and the intensity of prodromal or acute pain as risk factors for prolonged zoster-associated pain and persisting abnormal sensations in the affected dermatome. Ophthalmic zoster and pre-existing neurological disorders are also identified as highly significant risk factors for prolonged abnormal sensations in herpes zoster.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Female; Herpes Zoster; Humans; Male; Middle Aged; Pain; Prognosis; Treatment Outcome; Valacyclovir; Valine

To compare the efficacy and safety of valaciclovir and acyclovir in immunocompetent patients with herpes zoster ophthalmicus.. A multicenter, randomized, double-masked study.. One hundred ten immunocompetent patients with herpes zoster ophthalmicus diagnosed within 72 hours of skin eruption were treated; 56 were allocated to the valaciclovir group and 54 to the acyclovir group.. Patients randomized to the valaciclovir group received two 500-mg tablets of valaciclovir three times daily and one tablet of placebo twice daily. Patients in the acyclovir group received one 800-mg tablet of acyclovir five times daily and one tablet of placebo three times daily for 7 days.. Main outcome measures included the frequency, severity, and duration of ocular complications, patient reports of zoster-associated pain, and the outcome of skin lesions. Tolerance was also assessed on the incidence and types of adverse effects and changes in laboratory parameters. The analysis was mainly descriptive and performed on an intent-to-treat basis.. Ocular complications of herpes zoster ophthalmicus were similar in the valaciclovir and acyclovir treatment groups. The main complications were conjunctivitis (54% and 52%, respectively), superficial keratitis (39% and 48%, respectively for punctate keratitis; 11% in each group for dendritic keratitis), stromal keratitis (13% in each group), and uveitis (13% and 17%, respectively). The long-term outcomes of these ocular complications were favorable and similar in both treatment groups. Pain duration and severity and outcome of skin lesions were similar between groups. Most patients reported prodromal pain. After 1 month, 25% of patients in the valaciclovir group and 31% in the acyclovir group still reported pain. The percentage of patients experiencing postherpetic neuralgia decreased during follow-up. The tolerance to acyclovir and valaciclovir was comparable and considered good. The most frequent adverse events were vomiting and edema of the eyelids or face (3%-5%). Three serious adverse events not linked to the study drugs occurred.. Valaciclovir is as effective as acyclovir in preventing ocular complications of herpes zoster ophthalmicus, including conjunctivitis, superficial and stromal keratitis, and pain. Tolerability of the two drugs is similar, but the dosing schedule of valaciclovir is simpler.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Conjunctivitis, Viral; Double-Blind Method; Female; Herpes Zoster Ophthalmicus; Humans; Immunocompetence; Keratitis; Male; Middle Aged; Pain; Safety; Tablets; Uveitis; Valacyclovir; Valine

Acute neuritis and persistent pain are the most significant clinical manifestations of herpes zoster and are end points for clinical trials therapy. In an acyclovir and prednisone study, patients were categorized according to pain severity and number of lesions at presentation. Risk categories were defined according to the magnitude of risk ratios (RRs) and a comparison of Kaplan-Meier survival estimates. For acute neuritis and zoster-associated pain, RRs defined rate of resolution. Patients who presented with severe or incapacitating pain and a large number of lesions were less likely to achieve resolution of both acute neuritis and zoster-associated pain (RR, 18.0; 95% confidence interval [CI], 6. 6-48.6, and RR, 5.3; 95% CI, 4.2-17.2, respectively). These analyses identify the subgroups of patients for whom aggressive interventions are most strongly indicated.

Topics: Activities of Daily Living; Acyclovir; Aged; Anti-Inflammatory Agents; Antiviral Agents; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuritis; Pain; Prednisone; Quality of Life; Risk Factors; Time Factors

To compare valacyclovir hydrochloride with acyclovir in the treatment of recurrent genital herpes infection.. A multicenter, double-blind, placebo-controlled, randomized, parallel-design study.. University clinics (dermatology, gynecology, and infectious diseases) and private practices.. One thousand two hundred patients with recurrent genital herpes simplex infections.. Patients self-initiated oral therapy with 1000 mg of valacyclovir hydrochloride twice daily, 200 mg of acyclovir 5 times daily, or placebo for 5 days.. Resolution of all signs and symptoms of recurrent genital herpes infection.. Both drugs were significantly more effective than placebo in speeding resolution of herpetic episodes (median duration, 4.8, 4.8, and 5.9 days, respectively); the hazards ratios for valacyclovir and acyclovir vs placebo were 1.66 (95% confidence interval [CI], 1.38-2.01) and 1.71 (95% CI, 1.41-2.06) (both P < .001). Similarly, valacyclovir and acyclovir significantly hastened lesion healing (hazards ratios vs placebo were 1.88 [95% CI, 1.53-2.32] and 1.90 [95% CI, 1.55-2.34], respectively; P < .001). Pain duration was shorter in valacyclovir- and acyclovir-treated patients (median, 2 vs 3 days). Viral shedding stopped 2.55 times faster in patients treated with valacyclovir and 2.24 times faster in patients treated with acyclovir than in patients treated with placebo. Aborted episodes, in which lesions did not progress beyond the macule or papule stage, tended to occur in more patients treated with valacyclovir (25.9%) or acyclovir (24.8%) than in patients treated with placebo (19.8%). Valacyclovir and acyclovir did not differ significantly with regard to their respective effects on any of the above efficacy parameters. The nature, severity, and frequency of adverse events did not differ among the 3 treatment groups.. Twice-daily valacyclovir was as effective and well tolerated in the treatment of recurrent genital herpes simplex virus infection as 5-times-daily acyclovir. Therefore, valacyclovir could prove a useful alternative to acyclovir when convenience of dosing or compliance issues are the prime considerations in treatment.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Antiviral Agents; Confidence Intervals; Double-Blind Method; Female; Herpes Genitalis; Humans; Immunocompetence; Male; Middle Aged; Pain; Placebos; Prodrugs; Proportional Hazards Models; Recurrence; Remission Induction; Self Care; Time Factors; Valacyclovir; Valine; Virus Shedding; Wound Healing

Oral acyclovir has become the standard of care for treatment of acute herpes zoster. Netivudine is a novel antiviral with greater in-vitro activity against varicella zoster virus. It was compared with acyclovir in a randomized, double-blind, controlled trial in immunocompetent adults with herpes zoster. Patients with rash for less than 72 h were assigned to receive either acyclovir or netivudine, then assessed regularly for 6 months. No evidence for a dose response with netivudine was found, so intent-to-treat analyses of all 511 enrolled patients compared acyclovir with netivudine. The time to complete cessation of pain (P = 0.007) and to cessation of moderate to excruciating pain (P = 0.005) was accelerated in acyclovir recipients. Rash outcomes and adverse event profiles were similar for both treatments. This study has confirmed the efficacy of acyclovir in decreasing the duration and severity of pain following herpes zoster. Greater in-vitro activity of newer agents may not necessarily provide greater benefit in humans.

Topics: Acyclovir; Aged; Antiviral Agents; Arabinofuranosyluracil; Double-Blind Method; Drug Administration Schedule; Exanthema; Female; Herpes Zoster; Humans; Male; Middle Aged; Pain; Prognosis

To compare the safety and efficacy of topical 1% penciclovir cream with vehicle control cream (placebo) for the treatment of a recurrent episode of herpes simplex labialis (cold sores) in immunocompetent patients.. Randomized, double-blind, placebo-controlled, patient-initiated, 2-armed, parallel clinical trial. Patients were prospectively dispensed study medication, and treatment was self-initiated by the patient within 1 hour of the first sign or symptom of a recurrence.. A total of 31 ambulatory clinics in the United States in a variety of settings, including private practices, public health facilities, and universities.. Otherwise healthy individuals with a history of frequent episodes of herpes simplex labialis. A total of 2209 patients were enrolled and given study medication, and 1573 initiated treatment for a recurrence.. Topical 1% penciclovir cream or vehicle control cream. Subjects applied treatment every 2 hours while awake for 4 consecutive days.. Lesion healing was the primary efficacy variable. Secondary end points included time to loss of lesion pain and time to cessation of viral shedding.. Healing of classical lesions (vesicles, ulcers, and/or crusts) was 0.7 day faster for penciclovir-treated patients compared with those who received vehicle control cream (median, 4.8 days vs 5.5 days; hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.18-1.49; P<.001). Pain (median, 3.5 days vs 4.1 days; HR, 1.22; 95% CI, 1.09-1.36; P<.001) and lesion virus shedding (median, 3 days vs 3 days; HR, 1.35; 95% CI, 1.10-1.64; P=.003) also resolved more quickly for penciclovir-treated patients compared with patients who applied the vehicle control. The efficacy of penciclovir cream was apparent when therapy was initiated early (prodrome or erythema lesion stage) and when initiated late (papule or vesicle stage). The incidence of adverse events was comparable between penciclovir and placebo groups.. Penciclovir cream is the first treatment to clearly demonstrate an impact on the course of recurrent herpes labialis in immunocompetent patients. Efficacy was seen in all clinical and laboratory measures of the disease (lesion healing, pain resolution, and cessation of viral shedding). Faster healing and pain resolution occurred both among patients who first applied penciclovir cream in the prodrome and erythema stages and among those who started treatment in the papule and vesicle lesion stages.

Topics: Acyclovir; Administration, Topical; Adult; Aged; Antiviral Agents; Double-Blind Method; Female; Guanine; Herpes Labialis; Humans; Immunocompetence; Male; Middle Aged; Ointments; Pain; Proportional Hazards Models; Recurrence; Virus Shedding; Wound Healing

A randomized, double-blind trial at seven ski sites in Canada and the United States was conducted to compare the effectiveness and the patient tolerance of topically applied 5% acyclovir cream (MAC III formulation) with those of a placebo cream in the prevention of sun-induced herpes labialis lesions.. All subjects had experienced more than three episodes of sun-induced herpes labialis during the previous year. There were 196 subjects enrolled; 5 did not receive medication, and 10 were excluded from the efficacy analysis for protocol violations. There were 191 subjects in the intent-to-treat analysis, and a separate efficacy analysis was done on 181 subjects. Log rank and Fisher exact tests were used in the analysis.. There was no difference between the two groups at baseline with respect to any clinical or demographic factor. There was no substantial difference between the groups with respect to adverse experiences (15 for acyclovir; 13 for the placebo). The acyclovir group had significantly fewer lesions (p < 0.01) than the placebo group (21% vs. 40%) during the 4-day follow-up period.. The acyclovir group was significantly better than the placebo group during the follow-up period. The safety record of the drug was satisfactory; there was no difference between acyclovir and the placebo in side effects or pain. Topically applied 5% acyclovir cream is an effective preventive step for those who are active and exposed to the sun.

Topics: Acyclovir; Administration, Cutaneous; Adult; Antiviral Agents; Chemoprevention; Double-Blind Method; Female; Follow-Up Studies; Herpes Labialis; Humans; Linear Models; Male; Ointments; Pain; Placebos; Safety; Skiing; Sunlight

To determine the effect of acyclovir and prednisone treatment of herpes zoster on chronic pain and quality-of-life outcomes.. Randomized, double-blind, placebo-controlled study with a 2 x 2 factorial design.. 15 university hospitals or affilliated clinics.. 208 immunocompetent patients older than 50 years of age who had localized herpes zoster that developed less than 72 hours before study enrollment.. Acyclovir or a matched placebo was administered orally, 800 mg five times daily, for 21 days. Prednisone or a matched placebo was administered orally at 60 mg/d for the first 7 days, 30 mg/d for days 8 to 14, and 15 mg/d for days 15 to 21. The four treatments regimens given were acyclovir plus prednisone; acyclovir plus prednisone placebo; prednisone plus acyclovir placebo; and placebos for both acyclovir and prednisone.. Patients were monitored daily for the first 28 days for lesion healing, resolution of pain, return to usual activity, and return to uninterrupted sleep. Monitoring was then done monthly for 6 months. Patients documented analgesic requirements each day, and adverse events and laboratory abnormalities were recorded at each clinical visit. An intention-to-treat analysis was used.. Patients were randomly allocated to receive one of the four regimens. Demographic characteristics were similar for each group. Time to total crusting and healing was accelerated for patients receiving acyclovir plus prednisone compared with patients receiving two placebos; the risk ratios were 2.27 (95% Cl, 1.46 to 3.55) for total crusting and 2.07 (Cl, 1.26 to 3.38) for healing. Similarly, compared with the placebo group, patients receiving acyclovir plus prednisone had accelerated time to cessation of acute neuritis (risk ratio, 3.02 [Cl, 1.42 to 6.41]), time to return to uninterrupted sleep (risk ratio, 2.12 [Cl, 1.25 to 3.58]); time to return to usual daily activity (risk ratio, 3.22 [Cl, 1.92 to 5.40]); and time to cessation of analgesic therapy (risk ratio, 3.15 [Cl, 1.69 to 5.89]). In the acyclovir plus prednisone group, resolution of pain during the 6 months after disease onset did not statistically differ from that in the other groups. No important clinical or laboratory adverse events occurred in any group.. In relatively healthy persons older than 50 years of age who have localized herpes zoster, combined acyclovir and prednisone therapy can improve quality of life.

Topics: Acyclovir; Aged; Antiviral Agents; Chronic Disease; Drug Therapy, Combination; Female; Glucocorticoids; Herpes Zoster; Humans; Male; Middle Aged; Pain; Placebos; Prednisone; Quality of Life; Regression Analysis

Acyclovir treatment of acute herpes zoster speeds rash healing and decreases pain and ocular complications. The limited oral bioavailability of acyclovir necessitates frequent dosing. Valaciclovir, the l-valyl ester of acyclovir, is rapidly and almost completely converted to acyclovir in vivo and gives three- to fivefold increases in acyclovir bioavailability. In a randomized, double-blind, multicenter study, the safety and efficacy of oral valaciclovir given at a dosage of 1,000 mg three times daily for 7 or 14 days and oral acyclovir given at a dosage of 800 mg five times daily for 7 days were compared in immunocompetent adults aged > or = 50 years with herpes zoster. Patients were evaluated for 6 months. The intent-to-treat analysis (1,141 patients) showed that valaciclovir for 7 or 14 days significantly accelerated the resolution of herpes zoster-associated pain (P = 0.001 and P = 0.03, respectively) compared with acyclovir; median pain durations were 38 and 44 days, respectively, versus 51 days for acyclovir. Treatment with valaciclovir also significantly reduced the duration of postherpetic neuralgia and decreased the proportion of patients with pain persisting for 6 months (19.3 versus 25.7%). However, there were no differences between treatments in pain intensity or quality-of-life measures. Cutaneous manifestations resolved at similar rates in all groups. Adverse events were similar in nature and prevalence among groups, and no clinically important changes occurred in hematology or clinical chemistry parameters. Thus, in the management of immunocompetent patients > or = 50 years of age with localized herpes zoster, valaciclovir given at 1,000 mg three times daily for 7 days accelerates the resolution of pain and offers simpler dosing, while it maintains the favorable safety profile of acyclovir.

Topics: Acyclovir; Administration, Oral; Aged; Aged, 80 and over; Analgesics; Antiviral Agents; Double-Blind Method; Drug Administration Schedule; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Immunocompetence; Male; Middle Aged; Neuralgia; Pain; Quality of Life; Valacyclovir; Valine

In this paper, data from a clinical trial of a new antiviral agent for treating patients with zoster are used to answer the following question: Does the Nottingham Health Profile (NHP) add to the information obtained from the clinical measures? Three ways in which the NHP could add information are measured. First, Cox's regression analysis is used to determine whether health-related quality-of-life scores obtained at diagnosis give information about disease prognosis. Second, changes in mean NHP scores in different dimensions are computed after pain resolution to determine whether NHP scores provide more sensitive indicators of disease resolution. Third, linear regression is used to determine whether the impacts of disease on quality of life are measured adequately by the clinical parameters. These analyses show that use of the physical mobility and energy dimensions of the NHP increases understanding of disease prognosis; demonstrates the continuing impact of zoster on patients' sleep patterns and energy levels, disease symptoms not included as clinical measures, that persist after the cessation of zoster-associated pain; and gives a measure of the impact of zoster on the patient, which includes unmeasured and measured levels of severity.

Topics: Acyclovir; Antiviral Agents; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Middle Aged; Outcome Assessment, Health Care; Pain; Prognosis; Quality of Life; Regression Analysis; Sleep; Valacyclovir; Valine

46 patients with acute herpes zoster ophthalmicus of less than 72 hours duration were recruited into a placebo controlled trial to assess the efficacy of oral acyclovir, 800 mg 5 times daily, in preventing or modifying ocular complications and pain. Fewer acyclovir recipients developed intraocular complications and these were less severe but neither difference was statistically significant. However, active ocular disease was significantly less common in the acyclovir group (p = 0.01) at 6 months. Pain was significantly less severe in the acyclovir group between 2 and 6 months. The proportion of patients with pain scores greater than 0 was significantly lower in the acyclovir group between 2 and 3 months. Oral acyclovir appears to modify the disease process in herpes zoster ophthalmicus, to reduce the severity and incidence of postherpetic pain and especially to protect against long-term ocular complications.

Topics: Acute Disease; Acyclovir; Administration, Oral; Adult; Aged; Aged, 80 and over; Double-Blind Method; Drug Administration Schedule; Eye Diseases; Female; Follow-Up Studies; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Pain; Pain Measurement; Placebos; Steroids

Topics: Acyclovir; Administration, Oral; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Middle Aged; Pain; Pain Measurement; Random Allocation

Oral acyclovir at a dose of 800 mg five times daily for seven days was compared with placebo in a randomised double blind trial conducted at three centres in the United Kingdom. The study group comprised 205 elderly immune competent patients suffering from herpes zoster who were entered within 72 hours of the onset of rash. Acyclovir significantly reduced the times to arrest of new lesion formation (p = 0.005), loss of vesicles (p less than 0.001), and full crusting (p = 0.02) in those patients entered within 48 hours of the onset of rash. In addition, there was a significant reduction in pain during treatment with acyclovir as compared with placebo (p = 0.008). Of the patients with severe pain on entry, 40% (10/25) of those treated with acyclovir had no or only mild pain at the end of treatment, whereas in the placebo group all had residual moderate or severe pain (p less than 0.001). No clinically important adverse effects of acyclovir were reported. Oral acyclovir may modify acute herpes zoster and reduce pain.

Topics: Acute Disease; Acyclovir; Administration, Oral; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Pain; Random Allocation

Seventy-one nonimmunocompromised patients with herpes zoster ophthalmicus, presenting within seven days of onset of characteristic skin eruption, were enrolled in a prospective, longitudinal, randomized, double-masked, placebo-controlled trial with oral acyclovir. In a previous interim report we noted more prompt resolution of dermatomal signs and symptoms with acyclovir treatment. There was also a reduction of viral shedding in acyclovir-treated patients coupled with a trend to greater rate of microdissemination of the virus in placebo-treated patients (Cobo LM, et al. Ophthalmology 1985; 92:1574-83). While further substantiating these findings, we report that a ten-day course of treatment with oral acyclovir (600 mg, five times a day) is well-tolerated and significantly reduces the incidence and severity of the most common complications of herpes zoster ophthalmicus: dendritiform keratopathy, stromal keratitis, and uveitis. While this acyclovir treatment regimen reduces the zoster-related pain during the acute phase of the disease, especially in patients treated within 72 hours of onset of skin lesions, it has no evident effect on either incidence, severity, or duration of post-herpetic neuralgia in the patients studied.

Topics: Acute Disease; Acyclovir; Administration, Oral; Female; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Neuralgia; Pain; Skin

In a double-blind randomised trial 40 patients above 60 years old with acute herpes zoster received either 5 mg/kg acyclovir three times daily intravenously or 400 mg acyclovir five times daily orally for five days. Identical results were obtained with respect to duration of pain and rate of healing. Twenty per cent of orally administered acyclovir was absorbed and gave satisfactory concentrations of acyclovir in the vesicular fluid.

Topics: Acyclovir; Administration, Oral; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Injections, Intravenous; Male; Pain; Random Allocation

Forty-one patients with herpes zoster were treated with acyclovir or placebo at a dosage of 400 mg five times a day by mouth for five days in a double-blind randomized domiciliary study. Acyclovir was shown to reduce the days of new lesion formation within the effected dermatome after day 0 (P = 0.049). No other statistical difference was demonstrated between the two groups although the trends for new lesion formation outside the dermatome, full crusting, involution and diminution of acute pain all favoured acyclovir.

Topics: Acyclovir; Administration, Oral; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Middle Aged; Pain; Placebos; Random Allocation; Time Factors

Acyclovir given intravenously in either low dose (5 mg/kg every 8 h) or high dose (500 mg/m2 every 8 h) significantly reduced pain and accelerated skin healing in acute herpes zoster occurring in otherwise healthy adults. The higher dose also significantly reduced the duration of viral shedding. No significant effect on post-herpetic neuralgia could be demonstrated, although the higher dose showed a promising trend. No adverse effects were associated with the lower dose, but acyclovir at 500 mg/m2 resulted in nausea, vomiting and transiently elevated serum creatinine in a substantial number of patients.

Topics: Acyclovir; Adult; Creatinine; Follow-Up Studies; Herpes Zoster; Humans; Injections, Intravenous; Nausea; Pain; Random Allocation; Time Factors; Vomiting

31 adults took part in a randomised, placebo-controlled, double-blind trial of intravenous acyclovir therapy (500 mg/m2 intravenously 3 times daily for 5 days) for acute herpes zoster. Acyclovir reduced pain, decreased erythema, prevented the formation of new lesions, and healed skin faster than did placebo. The duration of viral shedding was also significantly shorter in acyclovir recipients (2 days versus 5 days). However, 6(35%) of 17 acyclovir recipients had recurrence of pain after the drug was discontinued, and acyclovir did not appear to affect post-herpetic neuralgia. Acyclovir therapy was associated with a transient rise in serum creatinine levels, and may have been related to nausea and vomiting. Intravenous acyclovir was effective therapy for acute herpes zoster but the ideal treatment regimen might be a lower daily dose given for a longer period.

Topics: Acute Disease; Acyclovir; Adult; Aged; Antiviral Agents; Clinical Trials as Topic; Double-Blind Method; Female; Guanine; Herpes Zoster; Humans; Injections, Intravenous; Male; Middle Aged; Pain; Random Allocation

Forty-three immunocompromised patients with progressive cutaneous herpes simplex virus infections were studied in a double-blind, placebo-controlled evaluation of topically applied acyclovir. Patients were randomized and 22 received acyclovir and 21 placebo; medications were applied four times daily for 10 days. Both study populations were balanced for all demographic characteristics. Acyclovir therapy resulted in no median differences in time to total healing compared with placebo responses, p = 0.13. However, those patients who received the acyclovir ceased shedding virus more rapidly, p less than 0.001, and lost pain more readily, p = 0.04, than placebo counterparts. Neither group experienced adverse effects. Because of the protracted nature of mucocutaneous herpes simplex infections in these patients, the immunocompromised host provides a good model for evaluation of topical antiviral therapy.

Topics: Acyclovir; Administration, Topical; Adult; Antiviral Agents; Clinical Trials as Topic; Double-Blind Method; Female; Guanine; Herpes Simplex; Humans; Immune Tolerance; Male; Pain; Placebos; Time Factors

Twenty-five patients with primary genital herpes were treated in a double-blind placebo-controlled randomized trial of intravenous acyclovir. Thirteen patients received the drug and 12 a placebo. Three in each group were male. In the acyclovir group 10 patients had true primary herpes compared with six in the control group. The median time to healing of all lesions was significantly decreased from 11 to seven days (p less than 0.05), and the median duration of viral shedding from all lesions was decreased from eight to two days (p less than 0.001). The time to cessation of new lesions was decreased from a median of two days to zero days (p less than 0.001). Intravenous acyclovir is an effective treatment in decreasing the length and severity of primary genital herpes.

Topics: Acyclovir; Antiviral Agents; Clinical Trials as Topic; Double-Blind Method; Female; Guanine; Herpes Genitalis; Humans; Infusions, Parenteral; Male; Pain; Time Factors

Topics: Acute Disease; Acyclovir; Adult; Age Factors; Aged; Antiviral Agents; Double-Blind Method; Drug Evaluation; Female; Guanine; Herpes Zoster; Humans; Male; Middle Aged; Pain

Topics: Acute Disease; Acyclovir; Aged; Clinical Trials as Topic; Double-Blind Method; Female; Guanine; Herpes Zoster; Humans; Injections, Intravenous; Male; Pain; Random Allocation

Herpes zoster is an infection caused by reactivation of varicella-zoster virus presenting as multiple grouped vesicular eruptions in a dermatomal pattern with associated pain. Recurrent herpes zoster is an uncommon event in an immunocompetent host. Here, we report a case of a young male presenting with herpes zoster over the T9 and T10 dermatome with the previous scarring of herpes zoster over the T6 dermatome over the right upper trunk. The patient improved on treatment with oral acyclovir and analgesics. In any patient with recurrenrt hepes zoster, work-up should be done to rule out immunosuppresion.

Topics: Acyclovir; Exanthema; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Pain

Topics: Acyclovir; Aged; Antiviral Agents; Coinfection; Cytomegalovirus Infections; Deglutition Disorders; Esophagitis; Esophagoscopy; Female; Ganciclovir; Herpes Simplex; Humans; Hypoalbuminemia; Immunocompetence; Pain; Parenteral Nutrition; Ulcer

Topics: Abdominal Muscles; Acyclovir; Antiviral Agents; Herpes Zoster; Humans; Immunoglobulin G; Male; Middle Aged; Pain; Paralysis; Valacyclovir; Valine

Rojas J. You're the flight surgeon: F-16 pilot with papular rash. Aerosp Med Hum Perform. 2016; 87(7):661-663.

Topics: Acyclovir; Adult; Analgesics, Opioid; Antiviral Agents; Erythema; Facial Dermatoses; Forehead; Herpes Zoster; Humans; Male; Military Personnel; Pain; Pilots; Vision Disorders

A 64-year-old woman developed acute paralysis of glossopharyngeal, vagus, accessory, and hypoglossal nerves on the left side after pain in the head and the left ear and throat. Cerebrospinal fluid examination revealed lymphocytic pleocytosis and elevated protein concentration. Varicella-zoster virus (VZV)-DNA was detected by PCR from cerebrospinal fluid. The diagnosis of lower cranial polyneuropathy due to VZV reactivation was made. After oral administration of an anti-viral agent and steroid, all symptoms and signs dramatically improved. Notably, there was no evidence of cutaneous or mucosal rash during the whole course of the disease. VZV reactivation should be included in the differential diagnosis of acute lower cranial polyneuropathy, especially with pain in the ear and throat, even without cutaneous or mucosal rash.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Betamethasone; Biomarkers; Cranial Nerve Diseases; DNA, Viral; Drug Therapy, Combination; Ear; Female; Herpesvirus 3, Human; Humans; Middle Aged; Pain; Pharynx; Treatment Outcome; Valacyclovir; Valine; Zoster Sine Herpete

The pain of acute herpes zoster (shingles) is severe and difficult to control. The medications used to control pain have a variety of important and potentially serious side effects. To the best of my knowledge, this is the first case report of using a plain topical occlusive dressing to reduce the pain of herpes zoster, avoiding the use of medication.. A 40-year-old Caucasian man and a qualified physician (the author), developed a dermatomal vesicular rash consistent with herpes zoster. Applying plain topical occlusive dressings reduced the severity of his pain to an ignorable level.. Plain topical occlusive dressings provide effective pain relief for acute herpes zoster, thereby avoiding the risks accompanying medication use.

Topics: Acyclovir; Adult; Antiviral Agents; Herpes Zoster; Humans; Male; Occlusive Dressings; Pain; Treatment Outcome; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Female; Herpes Zoster; Humans; Immunocompetence; Middle Aged; Pain; Skin Diseases, Viral

Topics: Acyclovir; Child; Exanthema; Female; Herpes Zoster; Humans; Pain

Topics: Acyclovir; Adult; Deglutition Disorders; Diagnosis, Differential; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Laryngitis; Laryngoscopy; Pain; Pharyngitis; Virus Activation

Topics: Acyclovir; Adult; Antiviral Agents; Diffusion Magnetic Resonance Imaging; Encephalitis, Viral; Herpesvirus 6, Human; Humans; Jaundice; Magnetic Resonance Imaging; Male; Neurologic Examination; Pain; Paresis; Polymerase Chain Reaction; Recovery of Function; Roseolovirus Infections; Tomography, X-Ray Computed; Treatment Outcome

TNF-α antagonists may increase the risk of herpes zoster (HZ), as well as the duration and severity. Recently, the monoclonal antibody ustekinumab, blocking the p40 subunit of IL-12 and IL-23, has been introduced for treating moderate to severe plaque psoriasis. There are no PubMed reports of HZ occurring in people receiving ustekinumab treatment. Common HZ was reported in clinical trials.. Two patients with severe psoriasis treated with ustekinumab developed severe contiguous multidermatomal HZ 1 and 9 months after treatment initiation.. The occurrence of HZ after the instauration of ustekinumab suggests a causal relationship. Indeed, the inhibition of the p40 subunit of IL-12 shifts the immune response towards a Th1 profile with diminished IFN-γ and TNF-α expression, decreasing the antiviral immune response.. Ustekinumab is probably a risk factor for developing HZ. Anti-HZ vaccination prior to ustekinumab treatment should be considered.

Topics: Acyclovir; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antiviral Agents; Dermatologic Agents; Herpes Zoster; Humans; Male; Middle Aged; Pain; Psoriasis; Severity of Illness Index; Treatment Outcome; Ustekinumab

Topics: Acyclovir; Adolescent; Antiviral Agents; Deglutition Disorders; Diagnosis, Differential; Esophagoscopy; Herpes Simplex; Humans; Male; Pain; Simplexvirus

Herein, we present a case of a parkinsonism-hyperpyrexia syndrome (PHS) in a 58-year-old man with a 10-year history of Parkinson's disease. The patient presented with a 2-week history of fever and increasing confusion, in the context of a number of changes to his medication regimen. On presentation, he was noted to be febrile with autonomic instability, diaphoresis and marked rigidity. He was disoriented and responding to visual hallucinations. Investigations revealed an elevated creatine kinase and a provisional diagnosis of PHS was made. After the patient failed to respond during a 2-week period to supportive measures, electroconvulsive therapy (ECT) treatment was commenced. A good response to eight bilateral ECT treatments was achieved, with resolution of his confusional state and associated psychotic phenomena. We discuss the nosological and management issues associated with this case and discuss the role of ECT as a treatment modality in this condition.

Topics: Acetaminophen; Acyclovir; Analgesics, Non-Narcotic; Analgesics, Opioid; Anti-Anxiety Agents; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antiparkinson Agents; Antiviral Agents; Anxiety; Carbidopa; Ceftriaxone; Cervical Vertebrae; Depression; Dexamethasone; Diazepam; Doxepin; Electroconvulsive Therapy; Humans; Levodopa; Male; Middle Aged; Neuroleptic Malignant Syndrome; Oxycodone; Pain; Parkinson Disease; Selegiline; Spinal Injuries

We present the case of a 38-yr-old woman who required an epidural blood patch in the context of acute varicella (chickenpox). The unique risks in this case include the possible triggering of central nervous system complications after the introduction of viremic blood into the epidural or intrathecal space. However, the risk was believed to be acceptable because the patient was receiving antiviral coverage. She enjoyed complete relief of her headache but experienced transient back and leg pain. Leptomeningeal irritation caused by acute varicella infection may put patients at increased risk for pain after epidural blood patch.

Topics: Acute Disease; Acyclovir; Adult; Antiviral Agents; Blood Patch, Epidural; Chickenpox; Female; Headache; Humans; Magnetic Resonance Imaging; Pain; Spinal Cord; Valacyclovir; Valine

To present a case of orbital myositis associated with herpes zoster ophthalmicus.. Observational case report.. A 47-year-old woman with acute retrobulbar eye pain and diplopia preceding the vesicular rash of herpes zoster ophthalmicus was evaluated and treated.. Magnetic resonance imaging showed enlargement and enhancement of extraocular muscles consistent with an inflammatory myopathy. Following acyclovir and prednisone treatment, all symptoms resolved, and neuralgia did not develop.. Herpes zoster may cause symptoms and signs of orbital myositis before eruption of cutaneous skin lesions and thus should be considered in the differential diagnosis of an acute orbital myositis.

Topics: Acyclovir; Anti-Inflammatory Agents; Antiviral Agents; Diplopia; Drug Therapy, Combination; Female; Herpes Zoster Ophthalmicus; Humans; Magnetic Resonance Imaging; Middle Aged; Oculomotor Muscles; Orbital Pseudotumor; Pain; Prednisone

Postherpetic neuralgia is pain that persists long after the disappearance of the cutaneous lesions of herpes zoster. However, the mechanisms of this delayed pain are unclear. Herpes simplex virus infection induces cutaneous lesions and pain-related responses in mice. The authors examined whether such responses would persist after the disappearance of the cutaneous lesions and whether some analgesics would be effective against them.. Female BALB/c mice were inoculated with herpes simplex virus type 1 on the unilateral hind paw. Pain-related responses of hind paw were determined using von Frey filaments. Beginning 5 days after inoculation, mice were given perorally the antiherpes agent acyclovir five times a day for 7 days. Effects of morphine (3-5 mg/kg subcutaneously), gabapentin (30-100 mg/kg perorally), mexiletine (10-30 mg/kg intraperitoneally), and diclofenac (30 mg/kg intraperitoneally) on pain-related responses were examined on days 25-35 after inoculation.. Viral inoculation induced cutaneous lesions and pain-related responses beginning on day 5 after inoculation. Acyclovir treatment healed all skin lesions by day 15 after inoculation. Approximately half of the mice given acyclovir showed pain-related responses at least until day 40 after inoculation. Morphine, gabapentin, and mexiletine dose-dependently inhibited pain-related responses, but diclofenac had no effects.. The authors show a mouse model of delayed postherpetic pain. This may be useful for manifesting the mechanisms of postherpetic neuralgia and the factors contributing to the transition from acute herpetic pain to delayed postherpetic pain. This may also be useful for the development of new analgesics against postherpetic neuralgia.

Topics: Acetates; Acute Disease; Acyclovir; Amines; Analgesics; Analgesics, Opioid; Animals; Antiviral Agents; Behavior, Animal; Cyclohexanecarboxylic Acids; DNA, Viral; Female; Gabapentin; gamma-Aminobutyric Acid; Herpesviridae Infections; Herpesvirus 1, Human; Mexiletine; Mice; Mice, Inbred BALB C; Morphine; Pain; Pain Measurement; Physical Stimulation

Topics: Acute Disease; Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Drug Therapy, Combination; Herpes Zoster; Humans; Pain

Human subjects infected with herpes or varicella-zoster viruses complain of pain, such as allodynia, in or near the region with vesicles. However, the mechanisms of the pain are unclear. We show for the first time that infection with herpes simplex virus type-1 (HSV-1) induces allodynia and hyperalgesia in mice. When HSV-1 was inoculated on the hind paw of the mouse, eruption appeared on the back on day 5 post-inoculation, and zosteriform skin lesions were developed on the inoculated side. Allodynia and hyperalgesia became apparent in the hind paw on the inoculated side on day 5 and persisted until at least day 8. HSV-1 DNA was detected in the dorsal root ganglia from days 2 to 8 post-inoculation, with a peak effect on day 5. The application of heat-inactivated HSV-1 induced no allodynia, hyperalgesia and skin lesion. When started from days 0 or 2, repeated treatment with acyclovir, anti-HSV-1 agent, inhibited the appearance of allodynia, hyperalgesia, eruption and the viral proliferation in the dorsal root ganglia. In contrast, when started from days 5 or 6, acyclovir treatment slightly inhibited the development of skin lesions and the viral proliferation, but not allodynia and hyperalgesia. These results suggest that the propagation of HSV-1 in the dorsal root ganglia produces allodynia and hyperalgesia as a result of functional abnormality of the sensory neurons in mice. This may be a useful model for studying the mechanisms of herpetic pain.

Topics: Acyclovir; Animals; Antiviral Agents; Behavior, Animal; DNA, Viral; Female; Ganglia, Spinal; Herpes Simplex; Herpesvirus 1, Human; Humans; Hyperalgesia; Mice; Mice, Inbred BALB C; Pain; Reverse Transcriptase Polymerase Chain Reaction; Skin

Topics: Acyclovir; Antiviral Agents; Combined Modality Therapy; Herpes Zoster; Humans; Nerve Block; Pain; Pain Management

Topics: Acyclovir; Adult; Antiviral Agents; Atlantic Islands; Causalgia; Chronic Disease; Female; Fibromyalgia; Herpesviridae Infections; Humans; Male; Middle Aged; Pain; Pain Management; Phantom Limb; Risk Factors; Spain; Syndrome; Time Factors

Topics: Acyclovir; Amitriptyline; Antidepressive Agents, Tricyclic; Antiviral Agents; Drug Therapy, Combination; Herpes Zoster; Humans; Male; Middle Aged; Pain

The efficacy of early versus late treatment with acyclovir and valaciclovir on zoster-associated pain was assessed from two databases (1076 patients) that were compiled from randomized trials. Early treatment was started < 48 h and late treatment was started 48-72 h after the onset of cutaneous herpes zoster. Median times to complete resolution of zoster-associated pain were 28 and 62 days, respectively, for patients (> or = 18 years of age) treated with acyclovir and placebo within 48 h (hazard ratio [HR], 1.68; 95% confidence limit [95% CL], 1.19, 2.38) and 28 and 58 days, respectively, for those treated later (HR, 2.20; 95% CL, 1.03, 4.71). In the valaciclovir versus acyclovir study (in patients > or = 50 years of age), the corresponding figures were 44 and 51 days for patients treated early (HR, 1.28; 95% CL, 1.03, 1.60) and 36 and 48 days for those treated later (HR, 1.40; 95% CL, 1.04, 1.87). Acyclovir significantly shortened the time to complete resolution of zoster-associated pain compared with placebo (and valaciclovir was superior to acyclovir in this regard) even when therapy was delayed up to 72 h after rash onset.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Antiviral Agents; Databases, Factual; Drug Administration Schedule; Female; Herpes Zoster; Humans; Male; Middle Aged; Pain; Randomized Controlled Trials as Topic; Valacyclovir; Valine

Oral acyclovir is a costly antiviral agent shown to be effective in the treatment of herpes zoster. Herpes zoster runs a relatively benign course in young, healthy individuals, as compared with elderly and immunologically compromised patients, in whom complications are common. This study attempts to assess the cost-benefit of treatment with oral acyclovir in young healthy adults with herpes zoster.. The records of 42 healthy young adults suffering from herpes zoster and treated with oral acyclovir (800 mg five times daily for 7 days) were compared with those of 40 healthy young adults with herpes zoster seen during the same period but treated without oral acyclovir. The duration of zoster-associated pain and the presence of complications were noted.. There was no statistically significant difference in the duration of zoster-associated pain between the two groups of patients (P = 0.11). Other complications of herpes zoster were few and similar in the two groups.. At a cost of $250 to $300 for a 7-day course of oral acyclovir, the use of this antiviral agent in healthy young individuals with herpes zoster is not justified, especially in developing countries with limited resources.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Age Factors; Aged; Antiviral Agents; Cost-Benefit Analysis; Developing Countries; Drug Costs; Female; Health Resources; Herpes Zoster; Humans; Immunocompromised Host; Male; Neuralgia; Pain; Retrospective Studies; Safety; Saudi Arabia; Time Factors; Treatment Outcome

Topics: Acyclovir; Antiviral Agents; Herpes Zoster; Humans; Immunocompetence; Pain

Topics: Acyclovir; Aged; Anti-Inflammatory Agents; Antiviral Agents; Drug Therapy, Combination; Evaluation Studies as Topic; Female; Herpes Zoster; Humans; Male; Middle Aged; Pain; Prednisone; Randomized Controlled Trials as Topic; Reproducibility of Results; Treatment Outcome

Topics: Acyclovir; Herpes Zoster Ophthalmicus; Humans; Pain; Randomized Controlled Trials as Topic

Three hundred and one patients with acute herpes zoster treated early with oral acyclovir were enrolled in an open, prospective study designed to evaluate painful and neurologic disorders over a 6-month period. Age, initial pain severity, and occurrence of a neurologic deficit influenced the incidence of postherpetic neuralgia. No relationship was found between initial rash severity and either pain incidence or neurologic deficit.

Topics: Acyclovir; Administration, Oral; Aged; Herpes Zoster; Humans; Middle Aged; Nervous System Diseases; Pain; Prospective Studies

Topics: Acyclovir; Antiviral Agents; Herpes Zoster; Humans; Pain; Valacyclovir; Valine

Oral manifestations of herpes zoster are very less common than cutaneous. Only a few cases of oral herpes zoster in children had been already described. Authors report a case of maxillary superior nerve's herpes zoster. Oral lesions are encountered in case of viral disease of the second and third branch of trigeminal nerve (VII, VIII). Dental pain is usually the first sign and can induce misdiagnosis. The diagnosis is based on the specific ulcerative lesions, strictly unilateral, developed in the field of sensitive innervation of the maxillary nerves. The use of antiviral drugs seems to be actually the best treatment.

Topics: Acyclovir; Child; Cranial Nerve Diseases; Female; Herpes Zoster; Humans; Maxillary Nerve; Mouth Diseases; Pain

Glycyrrhizin (GL) is a saponin widely used as an anti-inflammatory agent. Pain intensity and HLA-DR antigen expression on CD8+ cells were assessed during and after treatment with GL. Other agents such as acyclovir, gamma-globulin and interferon beta were also administered for comparison. Pain resolved most rapidly among those treated with acyclovir followed by those treated with GL. Pain resolution correlated with the regression of HLA-DR+ in CD8+ subpopulations in peripheral blood. GL is suggested to be an alternative or additive antiviral agent to herpes zoster.

Topics: Acyclovir; Adult; Aged; Antigens, Differentiation, T-Lymphocyte; Antiviral Agents; CD8 Antigens; Female; gamma-Globulins; Glycyrrhetinic Acid; Glycyrrhizic Acid; Herpes Zoster; HLA-DR Antigens; Humans; Interferon Type I; Male; Middle Aged; Neuralgia; Pain; T-Lymphocyte Subsets; T-Lymphocytes, Cytotoxic; T-Lymphocytes, Regulatory

Topics: Acetaminophen; Acyclovir; Advertising; Herpes Zoster; Humans; Pain

Topics: Acute Disease; Acyclovir; Humans; Joint Diseases; Pain; Recurrence; Stevens-Johnson Syndrome

Topics: Acyclovir; Administration, Oral; Drug Administration Schedule; Herpes Zoster; Humans; Pain

Topics: Acyclovir; Adult; Aged; Female; Herpes Zoster; Humans; Infusions, Intravenous; Male; Middle Aged; Pain

Topics: Acyclovir; Adult; Aged; Female; Herpes Zoster; Humans; Male; Middle Aged; Pain

Three patients in whom herpes zoster infections developed following bone marrow transplantation were treated with acyclovir. The patients experienced pain relief within 24 hours of starting treatment. The progression of their skin lesions halted within 1, 2, and 4 days of therapy, respectively, and healed completely within two weeks of therapy. Pharmacokinetic studies indicated that acyclovir plasma concentration-time profiles approximated biexponential equations. The drug half-lives were 3.91, 3.83, and 3.40 hours, respectively. Acyclovir was not myelotoxic and may be helpful in aborting varicella-zoster virus infections in bone marrow transplant recipients.

Topics: Acyclovir; Adolescent; Antiviral Agents; Bone Marrow Transplantation; Child; Female; Guanine; Half-Life; Herpes Zoster; Humans; Kinetics; Leukemia, Lymphoid; Male; Pain; Postoperative Complications