Page 879 - Basic _ Clinical Pharmacology ( PDFDrive )

CHAPTER 49 Antiviral Agents 865

TABLE 49–1 Agents to treat or prevent herpes simplex virus (HSV) and varicella-zoster virus (VZV) infections.

Agent Treatment of First Episode Treatment of Recurrent Episodes Suppression
Genital Herpes
Acyclovir, oral 1 400 mg tid × 7–10 days 800 mg tid × 2 days or 800 mg bid × 5 days 400–800 mg bid-tid 2
or 200 mg 5 times daily or 400 mg tid × 5 days
Famciclovir, oral 1 250 mg tid × 7–10 days 1000 mg bid × 1 day or 125 mg bid × 5 days 250–500 mg bid 2
or 500 mg once then 250 mg bid × 2 days 2
Valacyclovir, oral 1 1000 mg bid × 10 days 500 mg bid × 3 days or 1 g qd × 5 days 500–1000 mg qd–bid 2
Orolabial herpes
Acyclovir, oral 1 400 mg tid × 7–10 days 200–400 mg 5 times daily × 5 days 400–800 mg bid–tid 2
or 200 mg 5 times daily
Famciclovir, oral 1 500 mg tid × 7–10 days 1500 mg once or 750 mg bid 500 mg bid
Valacyclovir, oral 1 1 g bid × 7–10 days 2 g bid × 1 day 500–1000 mg qd
Acyclovir, topical (5% cream) 5 times daily × 4 days
Docosanol, topical (10% cream) 5 times daily
Penciclovir, topical (1% cream) Every 2 h while awake
Herpes proctitis, treatment
Acyclovir, oral 1 400 mg 5 times daily until healed
Severe HSV infection or HSV infection in the immunocompromised host, treatment
Acyclovir, IV 1 5–10 mg/kg q8h × 7–14 days
Herpes encephalitis, treatment
Acyclovir, IV 1 10–15 mg/kg q8h × 21 days
Neonatal HSV infection, treatment
Acyclovir, IV 1 10–20 mg/kg q8h × 14–21 days
Herpetic keratoconjunctivitis, treatment
Ganciclovir, topical (0.15% gel) 5 times daily
Trifluridine, topical (1% solution) Every 2 h while awake
Varicella infection, treatment
Acyclovir, oral 1 20 mg/kg (maximum 800 mg) qid × 5 days
Valacyclovir, oral 1 20 mg/kg (maximum, 1 g) tid × 5 days
Zoster infection, treatment
Acyclovir, oral 1 800 mg 5 times daily × 7–10 days
Famciclovir, oral 1 500 mg tid × 7 days
Valacyclovir, oral 1 1 g tid × 7 days
Severe VZV infection or VZV infection in the immunocompromised host, treatment
Acyclovir, IV 1 10–15 mg/kg q8h × ≥7 days
Acyclovir-resistant HSV or VZV infection, treatment
Foscarnet, IV 1 40–60 mg/kg q8h until healed 2
1
Dose adjustment is necessary for renal insufficiency.
2 Higher doses may be necessary in HIV-infected patients.
HIV, human immunodeficiency virus; HSV, herpes simplex virus; IV, intravenous; VZV, varicella-zoster virus.

The antiherpes agents significantly decrease the total number of the latter agents were associated with a shorter duration of zoster-
lesions, duration of symptoms, and viral shedding in patients with associated pain. Since VZV is less susceptible to the antiherpes
varicella (if begun within 24 hours after the onset of rash) or cutane- agents than HSV, higher doses are required (Table 49–1).
ous zoster (if begun within 72 hours); the risk of post-herpetic neu- The antiherpes agents may also be administered prophylacti-
ralgia is also reduced if treatment is initiated early. In comparative cally for the prevention of HSV or VZV infection in patients
trials with acyclovir for the treatment of patients with zoster, rates of undergoing organ transplantation, as well as for the treatment of
cutaneous healing with valacyclovir or famciclovir were similar, but these infections should they occur.