Acyclovir

阿昔洛韦
  • 文章类型: Journal Article
    单纯疱疹病毒或水痘带状疱疹病毒的临床再激活经常发生在恶性肿瘤患者中,特别是在接受强化化疗治疗的急性白血病患者中表现为单纯疱疹性口炎,在淋巴瘤或多发性骨髓瘤患者中表现为带状疱疹。近年来,对于常规化疗药物和许多新的抗肿瘤药物,对再激活率和临床表现的了解有所增加。本指南总结了目前关于未接受异基因或自体造血干细胞移植或其他细胞治疗(包括诊断、预防性,和治疗方面。特别是,概述了针对不同患者组的风险适应药物预防和疫苗接种策略.该指南更新了2015年德国血液和医学肿瘤学会(DGHO)传染病工作组(AGIHO)的指南“实体瘤和血液恶性肿瘤患者的抗病毒预防”,重点是单纯疱疹病毒和水痘带状疱疹病毒。
    Clinical reactivations of herpes simplex virus or varicella zoster virus occur frequently among patients with malignancies and manifest particularly as herpes simplex stomatitis in patients with acute leukaemia treated with intensive chemotherapy and as herpes zoster in patients with lymphoma or multiple myeloma. In recent years, knowledge on reactivation rates and clinical manifestations has increased for conventional chemotherapeutics as well as for many new antineoplastic agents. This guideline summarizes current evidence on herpesvirus reactivation in patients with solid tumours and hematological malignancies not undergoing allogeneic or autologous hematopoietic stem cell transplantation or other cellular therapy including diagnostic, prophylactic, and therapeutic aspects. Particularly, strategies of risk adapted pharmacological prophylaxis and vaccination are outlined for different patient groups. This guideline updates the guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) from 2015 \"Antiviral prophylaxis in patients with solid tumours and haematological malignancies\" focusing on herpes simplex virus and varicella zoster virus.
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  • 文章类型: Journal Article
    OBJECTIVE: The importance of compliance with National Comprehensive Cancer Network (NCCN) guidelines for preventing varicella-zoster virus reactivation (VZVr) in multiple myeloma (MM) in a clinical setting has not been well investigated.
    METHODS: We retrospectively studied the clinical characteristics and outcomes of 118 patients with MM treated with proteasome inhibitors.
    RESULTS: Thirty-nine episodes of VZVr were observed in 37 patients (VZVr group). The proportion of prophylactic antiviral prescriptions and compliance with antiviral prophylaxis based on the NCCN Clinical Practice guidelines was 76% and 30% in the VZVr group, and 88% and 74% in the non-VZVr group, respectively. Multivariate analysis showed that compliance with the NCCN guidelines was the only independent risk factor for VZVr (p=0.0017).
    CONCLUSIONS: It is important that prophylactic antivirals are prescribed for an appropriate duration of time to prevent the reactivation of VZV in compliance with existing guidelines.
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  • 文章类型: English Abstract
    This guideline is aimed at registrars and consultants in dermatology, ophthalmology, ENT, pediatrics, neurology, virology as well as infectiology, anaesthesia and generell medicine as well as policymakers and payers and purchasers of care. It was developed by dermatologists, virologists, ophthalmologists, ENT physicians, neurologists, pediatrician and anesthetists using a formal consensus process (S2k).The guideline provides an overview of clinical and molecular diagnostics as well as antigen detection, antibody culture and viral culture. Diagnostic special situations and complicated courses of the disease are also considered. The antiviral therapy of zoster and postzoster neuralgia is presented in general and for special situations. Detailed information on the treatment of pain is mentioned and presented in an overview. Likewise, the local therapeutic measures are discussed.
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  • 文章类型: Letter
    暂无摘要。
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    文章类型: Case Reports
    Reactivation of the varicella-zoster virus (VZV) causes dermatomal herpes zoster (HZ) and more rarely severe disseminated HZ including diffuse rash, encephalitis, hepatitis, and pneumonitis. An atypical form of VZV infection, disseminated HZ has been described primarily in immunocompromised hosts. We report 2 cases of atypical disseminated HZ in immunocompromised patients presenting with diffuse, nondermatomal, vesicular eruptions. We also provide a review of the literature and summarize the current guidelines for the treatment and prophylaxis of HZ in patients with human immunodeficiency virus (HIV) infection, solid organ transplantation (SOT), and hematopoietic stem cell transplantation (HSCT). Given the atypical presentation of VZV infection among some immunocompromised patients, this case series emphasizes the need for clinical suspicion for disseminated HZ to facilitate timely diagnosis and initiation of antiviral therapy. Clinician awareness of methods for prevention and treatment of VZV infection in immunocompromised individuals also is critical to minimize the risk for disease and associated morbidity in these patients.
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  • 文章类型: Journal Article
    目的:为妊娠期和产后早期生殖器疱疹的治疗提供指导。
    方法:MedLine和CochraneLibrary数据库搜索和审查主要的国外指南。
    结果:在怀孕期间首次发作生殖器疱疹的情况下,推荐使用阿昔洛韦(200mg,每天5次)或伐昔洛韦(1000mg,每天2次)进行5至10天的抗病毒治疗(C级)。如果以前没有进行过HIV检测,则应对患者进行HIV检测(B级)。每天使用阿昔洛韦(400mg,每天3次)或伐昔洛韦(500mg,每天两次)的抑制性抗病毒治疗,建议从36周开始,用于怀孕期间首次发作生殖器疱疹(B级)的女性。如果怀疑在分娩开始时首次出现生殖器疱疹(B级)或足月胎膜早破(专业共识),应进行剖宫产,或在分娩前不到6周首次发作生殖器疱疹的情况下(专业共识)。如果在产后期间突出出现首发生殖器疱疹,应告知新生儿学家(专业共识)。可以根据上述方案治疗患者。
    结论:首次生殖器疱疹在分娩前6周以内应行剖宫产。
    OBJECTIVE: To provide guidelines for the management of first episode genital herpes during pregnancy and in the immediate postpartum period.
    METHODS: MedLine and Cochrane Library databases search and review of the main foreign guidelines.
    RESULTS: In case of first episode genital herpes during pregnancy, antiviral treatment with acyclovir (200mg 5 times daily) or valacyclovir (1000mg twice daily) for 5 to 10 days is recommended (grade C). The patient should be tested for HIV if not previously done (grade B). Daily suppressive antiviral treatment with acyclovir (400mg 3 times daily) or valacyclovir (500mg twice daily) is recommended from 36 weeks for women who have had a first episode genital herpes during pregnancy (grade B). A cesarean section should be performed in case of suspicion of first episode genital herpes at the onset of labor (grade B) or premature rupture of the membranes at term (professional consensus), or in case of first episode genital herpes less than 6 weeks before delivery (professional consensus). In the event of first episode genital herpes highlighted in the postpartum period, the neonatologist should be informed (professional consensus). The patient may be treated according the scheme described above.
    CONCLUSIONS: A cesarean section should be performed in case of first episode genital herpes less than 6 weeks before delivery.
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  • 文章类型: Journal Article
    OBJECTIVE: To provide recommendations for the management of genital herpes infection in women who want to get pregnant or are pregnant and for the management of genital herpes in pregnancy and strategies to prevent transmission to the infant.
    RESULTS: More effective management of complications of genital herpes in pregnancy and prevention of transmission of genital herpes from mother to infant.
    METHODS: Medline was searched for articles published in French or English related to genital herpes and pregnancy. Additional articles were identified through the references of these articles. All study types and recommendation reports were reviewed.
    METHODS: Recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care.
    CONCLUSIONS: VALIDATION: These guidelines have been reviewed and approved by the Infectious Diseases Committee of the SOGC.
    BACKGROUND: The Society of Obstetricians and Gynaecologists of Canada.
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  • 文章类型: Journal Article
    Herpes zoster (HZ, shingles) is a frequent medical condition which may severely impact the quality of life of affected patients. Different therapeutic approaches to treat acute HZ are available. The aim of this European project was the elaboration of a consensus-based guideline on the management of patients who present with HZ, considering different patient populations and different localizations. This interdisciplinary guideline aims at an improvement of the outcomes of the acute HZ management concerning disease duration, acute pain and quality of life of the affected patients and at a reduction in the incidence of postherpetic neuralgia (PHN) and other complications. The guideline development followed a structured and pre-defined process, considering the quality criteria for guidelines development as suggested by the AGREE II instrument. The steering group was responsible for the planning and the organization of the guideline development process (Division of Evidence-Based Medicine, dEBM). The expert panel was nominated by virtue of clinical expertise and/or scientific experience and included experts from the fields of dermatology, virology/infectiology, ophthalmology, otolaryngology, neurology and anaesthesiology. Recommendations for clinical practice were formally consented during the consensus conference, explicitly considering different relevant aspects. The guideline was approved by the commissioning societies after an extensive internal and external review process. In this second part of the guideline, therapeutic interventions have been evaluated. The expert panel formally consented recommendations for the treatment of patients with HZ (antiviral medication, pain management, local therapy), considering various clinical situations. Users of the guideline must carefully check whether the recommendations are appropriate for the context of intended application. In the setting of an international guideline, it is generally important to consider different national approaches and legal circumstances with regard to the regulatory approval, availability and reimbursement of diagnostic and therapeutic interventions.
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  • 文章类型: Journal Article
    A physician has to perform a benefit-risk assessment each time acyclovir is prescribed \"off label\" for children. A group of Polish infectious disease experts was created to develop evidence-based guidelines on the use of acyclovir in the treatment and prevention of varicella zoster and herpes simplex infections. In primary varicella zoster virus infections, oral acyclovir treatment is recommended in children over 12 years of age and should be considered in younger children who fall into one of the groups at risk of severe varicella. Intravenous acyclovir therapy in varicella is recommended in patients with immune deficiencies, newborns and in complicated cases. When there is a justified need for prevention of varicella, oral acyclovir prophylaxis may be considered if immunoglobulin cannot be administered, and if it is too late for vaccination. Oral acyclovir treatment of herpes zoster may be beneficial to otherwise healthy patients with a rash in places other than the trunk and in patients over 50 years of age. In immunocompetent patients with herpes simplex infections, indications for treatment with oral acyclovir include primary (genital herpes, skin herpes in children with atopic dermatitis, ocular herpes simplex, severe gingivostomatitis, paronychia and pharyngitis) and recurrent infections. Intravenous acyclovir should be administered for herpes infections in neonates, immunocompromised patients and patients who develop complications including neurological.
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  • 文章类型: Journal Article
    OBJECTIVE: Herpes simplex virus (HSV) is rare in neonates but carries significant morbidity and mortality in that group. Emergency department (ED) clinicians have little guidance to decide when to test for HSV and give acyclovir. We created an institutional guideline to provide guidance in patients younger than 6 weeks. Our objective was to evaluate whether guideline implementation affected the ED\'s decision to test for HSV, and ED use of HSV polymerase chain reactions (PCRs) and acyclovir.
    METHODS: We reviewed charts for patients 1 year before implementation and 1 year after implementation of our guideline. Inclusion criteria were younger than 60 days, admitted through the ED, symptom onset younger than 6 weeks, and any one of the following criteria: (1) ED blood culture obtained, (2) ED or inpatient HSV PCR obtained, and (3) ED or inpatient acyclovir treatment. Premature patients and transfer patients were excluded. We compared whether the decision to initiate HSV testing, ED use of HSV PCRs, serum alanine aminotransferase, and acyclovir use changed post-guideline implementation.
    RESULTS: We reviewed 173 charts pre-implementation and 129 post-implementation. We found a significant decrease in ED testing for HSV among patients who did not meet guideline criteria (P < 0.01). We saw an improvement in the use of alanine aminotransferase among patients who met criteria for testing (P = 0.02), but no change in the use of HSV PCRs or acyclovir use among tested patients.
    CONCLUSIONS: Guideline implementation reduced HSV evaluations in low-risk patients, but did not improve test utilization or acyclovir administration among those tested. Additional work is needed to improve guideline utilization.
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