Herpes simplex treatment: Difference between revisions
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====Docosanol==== | ====Docosanol==== | ||
* [[Docosanol]] prevents herpes simplex virus from fusing to cell membranes, thus barring the entry of the virus into the skin. | * [[Docosanol]] prevents herpes simplex virus from fusing to cell membranes, thus barring the entry of the virus into the skin. | ||
* | * It was approved for use after clinical trials by the [[FDA]] in July 2000.<ref>{{cite web | title = Drug Name: ABREVA (docosanol) - approval | work = | publisher = centerwatch.com | date = July 2000 | url = http://www.centerwatch.com/patient/drugs/dru627.html| format = | doi = | accessdate = 2007-10-17 }}</ref> | ||
* It was the first [[over-the-counter drug|over-the-counter]] [[antiviral drug]] approved for sale in the [[United States]] and [[Canada]] | * It was the first [[over-the-counter drug|over-the-counter]] [[antiviral drug]] approved for sale in the [[United States]] and [[Canada]] | ||
Revision as of 22:06, 15 September 2011
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Currently, there is no treatment that can eradicate any of the herpes viruses from the body. Non-prescription analgesics can reduce pain and fever during initial outbreaks. Topical anesthetic treatment (such as prilocaine, lidocaine or tetracaine) can relieve itching and pain.[1][2]
Antiviral Medication
Mechanism of benefit:
- Antiviral medications used against herpes viruses work by interfering with viral replication, effectively slowing the replication rate of the virus and providing a greater opportunity for the immune response to intervene.
- All drugs in this class depend on the activity of the viral enzyme, thymidine kinase, to convert the drug sequentially from its prodrug form to a monophosphate (with one phosphate group), diphosphate (with two phosphate groups) and, finally, triphosphate (with three phosphate groups) form that interferes with viral DNA replication.[3]
Types of anti-viral medications:
- There are several prescription antiviral medications for controlling herpes simplex outbreaks, including aciclovir (Zovirax), valaciclovir (Valtrex), famciclovir (Famvir), and penciclovir.
- Valaciclovir and famciclovir are prodrugs of aciclovir and penciclovir respectively, which have improved solubility in water and better bioavailability when taken orally.[3] The use of valaciclovir and famciclovir, while potentially improving treatment compliance and efficacy, are still undergoing safety evaluation in this context. There is evidence in mice that treatment with famciclovir, rather than aciclovir, during an initial outbreak can help lower the incidence of future outbreaks by reducing the amount of latent virus in the neural ganglia. This potential effect on latency over aciclovir drops to zero a few months post-infection.[5]
Antiviral treatment of First episode genital herpes
Antiviral treatment of Recurrent genital herpes
Antiviral treatment for Severe Disease:
- IV acyclovir therapy should be provided for patients who have severe HSV disease or complications that necessitate hospitalization (e.g., disseminated infection, pneumonitis, or hepatitis) or CNS complications (e.g., meningitis or encephalitis).
- The recommended regimen is acyclovir 5-10 mg/kg body weight IV every 8 hours for 2-7 days or until clinical improvement is observed, followed by oral antiviral therapy to complete at least 10 days total therapy.[6]
Topical treatments
Docosanol
- Docosanol prevents herpes simplex virus from fusing to cell membranes, thus barring the entry of the virus into the skin.
- It was approved for use after clinical trials by the FDA in July 2000.[7]
- It was the first over-the-counter antiviral drug approved for sale in the United States and Canada
Tromantadine
- Tromantadine is available as a gel that inhibits entry and spreading of the virus by altering the surface composition of skin cells and inhibiting release of viral genetic material.
Zilactin
- It is a topical analgesic barrier treatment, which forms a "shield" at the area of application to prevents a sore from increasing in size and decrease viral spreading during the healing process.
Other drugs
Cimetidine, a common component of heartburn medication, has been shown to lessen the severity of herpes zoster outbreaks in several different instances, and offered some relief from herpes simplex.[8][9][10] This is an off-label use of the drug. It and probenecid have been shown to reduce the renal clearance of aciclovir.[11] These compounds also reduce the rate, but not the extent, at which valaciclovir is converted into aciclovir.
Limited evidence suggests that low dose aspirin (125 mg daily) might be beneficial in patients with recurrent HSV infections. Aspirin (also called acetylsalicylic acid) is an non-steroidal anti-inflammatory drug, which reduces the level of prostaglandins - naturally occurring lipid compounds - that are essential in creating inflammation.[12] A recent study in animals showed inhibition of thermal (heat) stress-induced viral shedding of HSV-1 in the eye by aspirin, and a possible benefit in reducing the frequency of recurrences.[13]
References
- ↑ "Local anesthetic creams". BMJ. 297 (6661): 1468. 1988. PMID 3147021.
- ↑ Kaminester LH, Pariser RJ, Pariser DM; et al. (1999). "A double-blind, placebo-controlled study of topical tetracaine in the treatment of herpes labialis". J. Am. Acad. Dermatol. 41 (6): 996–1001. PMID 10570387.
- ↑ 3.0 3.1 De Clercq E, Field HJ (2006) Antiviral prodrugs - the development of successful prodrug strategies for antiviral chemotherapy. Br J Pharmacol 147 (1):1-11. DOI:10.1038/sj.bjp.0706446 PMID: 16284630
- ↑ Leung DT, Sacks SL (2003) Current treatment options to prevent perinatal transmission of herpes simplex virus. Expert Opin Pharmacother 4 (10):1809-19. DOI:10.1517/14656566.4.10.1809 PMID: 14521490
- ↑ Thackray AM, Field HJ (1996) Differential effects of famciclovir and valaciclovir on the pathogenesis of herpes simplex virus in a murine infection model including reactivation from latency. J Infect Dis 173 (2):291-9. PMID: 8568288
- ↑ Centers for Disease Control and Prevention. Workowski KA, Berman SM (2006) Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep 55 (RR-11):1-94. PMID: 16888612
- ↑ "Drug Name: ABREVA (docosanol) - approval". centerwatch.com. July 2000. Retrieved 2007-10-17.
- ↑
Another treatment, if not very medical, is the use of vaseline, or any other type of fat. This will ban water, or saliva, from reaching the cold sore. as the cold sore "feeds" itself from water, this will end its existence in a day or two.
Kapinska-Mrowiecka M, Toruwski G (1996.). "Efficacy of cimetidine in treatment of herpes zoster in the first 5 days from the moment of disease manifestation". Pol Tyg Lek. 51 (23–26): 338–339. PMID 9273526. Check date values in:
|year=(help) - ↑ Hayne ST, Mercer JB (1983). "Herpes zoster:treatment with cemetidine". Can Med Assoc J. 129 (12): 1284–1285. PMID 6652595.
- ↑ Komlos L, Notmann J, Arieli J, et.al. (1994). "In vitro cell-mediated immune reactions in herpes zoster patients treated with cimetidine". Asian Pac J Allelrgy Immunol. 12 (1): 51–58. PMID 7872992.
- ↑ De Bony F, Tod M, Bidault R, On NT, Posner J, Rolan P. (2002). "Multiple interactions of cimetidine and probenecid with valaciclovir and its metabolite acyclovir". Antimicrob. Agents Chemother. 46 (2): 458–463. PMID 11796358.
- ↑ Karadi I, Karpati S, Romics L. (1998). "Aspirin in the management of recurrent herpes simplex virus infection". Ann. Intern. Med. 128 (8): 696–697. PMID 9537952.
- ↑ Gebhardt BM, Varnell ED, Kaufman HE. (2004). "Acetylsalicylic acid reduces viral shedding induced by thermal stress". Curr. Eye Res. 29 (2–3): 119–125. PMID 15512958.