use of antivirals in hepes zoster

dear dermatologist members,is there any role of using systemic or local antiviral drugs in established cases of herpes zoster .

Posted by: abidranaPosts: 19 :: 20-08-2002 :: | Reply to this Message

Re: use of antivirals in hepes zoster

quote:

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abidrana wrote:
dear dermatologist members,is there any role of using systemic or local antiviral drugs in established cases of herpes zoster .

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Aciclovir is indicated for H.Zoster. Best time to start treatment is when you get the tingling sensation long before the blister formation. Once disease is stabilished - role of aciclovir is debatable. If I had shingles - I would take aciclovir, whatever is stage of disease as it might reduce long term problems such as post herpetic neuralgia.

I would give aciclovir 800 mgs, 5 X daily for 7 days.

There is no benefit in topical antiviral drugs. I would use simple vaseline on the blisters or use a topical antibiotic to prevent secondary infection

[Edited by memon on 08-20-2002 at 06:26 PM GMT]

Posted by: memonPosts: 28 :: 20-08-2002 :: | Reply to this Message

Re: use of antivirals in hepes zoster

is there any documented role of inj.steroid in case of herpes zoster .As in one seminar dermatologist claimed to have been using inj.steroid for initial 2 days.In his opinion ,it prevents from possible complication of deadly post herpetin neuralgia.What is your opinion.

Posted by: abidranaPosts: 19 :: 21-08-2002 :: | Reply to this Message

Re: Re: use of antivirals in hepes zoster

quote:

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abidrana wrote:
is there any documented role of inj.steroid in case of herpes zoster .As in one seminar dermatologist claimed to have been using inj.steroid for initial 2 days.In his opinion ,it prevents from possible complication of deadly post herpetin neuralgia.What is your opinion.

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There are studies suggesting that steroids may reduce the post herpetic neuralgia. Equally there are studies saying steroids increase complications and do not prevent neuralgia.

Generally speaking, steroids are not used routinely in H. Zoster infection.

Posted by: memonPosts: 28 :: 21-08-2002 :: | Reply to this Message

Re: use of antivirals in hepes zoster

Routine use of steroids woithout concomitnt use of antivirals is NOT recomeended..
NEJM Volume 347:340-346 latest Clinical Prctice Article in New England Journal of Medicine of 1st AUgust, 2002

Naghman

Posted by: naghmanPosts: 3 :: 24-08-2002 :: | Reply to this Message

Re: Re: use of antivirals in hepes zoster

Is there any difference in recommendation for using antiviral in cases of herpes zoster in immunocompetent & immunocompromized pateints??

quote:

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naghman wrote:
Routine use of steroids woithout concomitnt use of antivirals is NOT recomeended..
NEJM Volume 347:340-346 latest Clinical Prctice Article in New England Journal of Medicine of 1st AUgust, 2002

Naghman

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Posted by: drsh91Posts: 2 :: 25-08-2002 :: | Reply to this Message

Re: Re: Re: use of antivirals in hepes zoster

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drsh91 wrote:
Is there any difference in recommendation for using antiviral in cases of herpes zoster in immunocompetent & immunocompromized pateints??

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No, there is no difference.

There is no role for topical anti-virals, steroids or interferon injections.

Recommended treatment is as follows:

Acyclovir (Zovirax): 400 mg orally three times/day for 7-10 days.
or
Valaciclovir (Valtrex): 1 G orally twice a day for 7-10 days.
or
Famciclovir (Denavir or Femvir): 250 my orally three times a day for 7-10 days.

Occasionally a patient with other complications or generalized disease may not respond to oral therapy. In that situation, Acyclovir 5-10 mg/kg IV every 8 hours would be recommended.

This will only alleviate the symptoms but will not kill the virus or prevent recurrence.

If there is no response with the above, then Foscavir 40 mg/kg IV every 8 hours untill there is clinical resolution or development of side effects.

If no improvement after all this, pray to God.



[Edited by chameed on 08-26-2002 at 10:26 AM GMT]

[Edited by chameed on 08-26-2002 at 10:27 AM GMT]

Posted by: chameedPosts: 173 :: 26-08-2002 :: | Reply to this Message