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Do you want to know how psychics mediums prepare for psychics readings? Company secrets can be taken by a disgruntled employee, for example. Intravenous acyclovir remains the most effective form of treatment for a primary genital herpes infection, leading to significant reduction in time to cessation of viral shedding and pain. Time to lesion healing is also 6 days faster than with placebo alone 8 days vs 14 days.

However, as IV administration of acyclovir requires hospitalization, this route is reserved for patients with life-threatening disease or systemic complications Whitley et al The current standard of therapy is oral medication.

In addition to acyclovir, valacyclovir and famciclovir are the other oral agents approved for treatment of recurrent genital herpes.

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All three drugs have similar efficacy in the treatment of genital herpes and have been shown to expedite lesion healing time by approximately 1—2 days when compared with placebo Sacks et al ; Tyring et al ; Chosidow et al Their differences are revealed in their pharmacokinetic properties, which dictate their dosing schedules.

Acyclovir was traditionally dosed as mg five times daily for 5 days, mainly due to its aforementioned unfavorable pharmacokinetic profile Reichman et al Such a regimen is extremely inconvenient and may contribute to poor patient compliance. Recently, however, shorter 2- to 3-day high-dose regimens of acyclovir and valacyclovir have also proven effective Reitano et al ; Tyring et al ; Leone et al ; Wald et al Based on the recent successes of high-dose acyclovir and valacyclovir regimens and the unique pharmacokinetic profile of famciclovir, an international, multicenter, randomized, double-blind, placebo-controlled trial was conducted to evaluate the efficacy of single-day famciclovir as a patient-initiated treatment for recurrent genital herpes in immunocompetent patients Aoki et al Selection criteria stipulated that participants be healthy individuals with proven HSV-2 infection and at least 4 recurrences in the preceding 12 months.

If on suppressive antiviral therapy at the time of enrollment, subjects must have had at least 4 recurrences in the 12 months prior to initiation of suppressive therapy and must have agreed to discontinue this therapy. Overall, the patient demographics and baseline disease characteristics were well matched between the treatment and placebo arms.

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Patients were followed daily in the clinic for the first 5 days and then every other day until all lesions had healed or day 14 was reached. The results of this study indicated that patients treated with single-day, high-dose famciclovir experienced almost a 2-day improvement in lesion healing time 1.

Furthermore, treatment with famciclovir halted progression to a full genital herpes outbreak in nearly one in four patients; aborted lesions were observed in Finally, high-dose famciclovir was well-tolerated by study participants, with only mild to moderate adverse events, which seemed to be transient in nature and similarly occurred in the placebo group.

The most common side effects reported were headaches and GI distress diarrhea, nausea, and abdominal pain , with headaches occurring more frequently in the treatment group Efficacy of single-day famciclovir compared to standard 2- to 5-day antiviral regimens in the treatment of recurrent genital herpes. All values reported as treatment vs placebo unless otherwise specified. Although no head-to-head trials have compared single-day famciclovir to the currently prescribed 2- to 5-day antiviral regimens, it appears to produce similar or better reductions in time to lesion healing and resolution of symptoms Table 1.

Additionally, single-day famciclovir also prevents progression to a full genital herpes outbreak as effectively as, or even more effectively than, other antiviral regimens. This single-day treatment design introduces a high load of antiviral agent into the body during the time of maximal viral replication, preventing the tissue damage and breakdown, and reducing symptoms that typically occur in recurrent episodes of genital herpes.

Furthermore, single-day therapy maximizes patient convenience and minimizes cost Table 2. To date, famciclovir is the only antiviral agent proven effective as single-day therapy of genital herpes.

The first antiviral agents used for the treatment of recurrent orolabial herpes were formulated in creams. Clinical trials have shown that topical antivirals speed healing and lessen pain, but require diligent application to affected areas. Subjects in the penciclovir studies applied medication to the affected area within 1 hour of prodrome onset and continued to do so every 2 hours for 4 consecutive days.

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Interestingly, both topical acyclovir and penciclovir display therapeutic efficacy in early as well as late stage lesions Spruance et al Compared to topical treatments, oral agents offer the benefit of less frequent dosing and increased bioavailability. Acyclovir, famciclovir, and valacyclovir are the most commonly used oral antivirals in the treatment of orolabial herpes. Oral acyclovir has been shown in two clinical trials to have modest efficacy in decreasing healing time and duration of pain when given early in the prodromal stages of recurrent orolabial herpes.

It has no effect on the development of secondary lesions. The current recommended dosing schedule is mg 5 times a day for 5 days Jensen et al Oral famciclovir given as a single mg dose was FDA approved for the treatment of recurrent orolabial herpes in immunocompetent patients after the seminal work by Spruance and coworkers in Spruance et al Subjects returned to the clinic within 24 hours for assessment.

The primary efficacy endpoint was healing, defined by loss of crust and re-epithelialization, of the primary vesicular lesion.

The secondary efficacy variables were time to healing of all vesicular lesions primary and secondary , time to return to normal skin for all lesions vesicular and aborted , and duration of pain.

Both famciclovir arms significantly decreased median time to healing of primary vesicular lesions vs. All lesions healed a median of 2.

Healing time was not significantly different between the two treatment arms. Incidence of headache and nausea in the treatment groups was similar to that of placebo. Headache was experienced by 9. Nausea occurred in 2.

Efficacy of single-day famciclovir compared to single-day valacyclovir in the treatment of recurrent orolabial herpes. DB, double-blind; PC, placebo-controlled; R, randomized. Rapidly absorbed and hydrolyzed into acyclovir and L-valine, valacyclovir has three to five times the bioavailability of traditional oral acyclovir Ormrod and Goa ; Spruance et al Two large double-blind, randomized, placebo-controlled studies demonstrated that 2 g of valacyclovir twice a day for 1 day single-day treatment and 2 g of valacyclovir given twice a day for 1 day followed by 1 g twice a day for 1 day 2-day treatment both significantly shortened the time to healing of cold sore lesions and duration of pain compared to placebo.

Patients initiated treatment at the first sign of prodromal symptoms and appeared in clinic within 24 hours for evaluation. The primary efficacy measure in Study 1 was the duration of the episode, measured from the start of treatment until healing, as defined by loss of crust on vesicular lesions and return to normal skin on non-vesicular lesions.

The primary efficacy measure in Study 2 was the proportion of subjects in which cold sore development was prevented.

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There was no added benefit in treating for 2 days vs 1 day. Development of new lesions was decreased in the treated groups, but not to a statistically significant amount compared to placebo. The only adverse event that occurred with a greater frequency in the treated subjects was headache: These two studies show that single-day high dose 2 g bid course of valacyclovir safely and effectively reduces healing time of cold sores by an average of 1 day compared to placebo.

There is no additional benefit in treating for 2 days. While clinical trials show that topical agents are efficacious, patients in the real world are unlikely to comply with the frequent dosing schedule required for optimal results, making oral antiviral agents the most convenient option for patient-initiated episodic therapy. Although no head-to-head comparisons of orolabial herpes therapies exist, oral famciclovir and valacyclovir appear to offer similar reductions in duration of lesions and associated pain Table 3.

Mucocutaneous infections caused by herpes simplex viruses in immunocompetent patients are usually self-limiting, although their impact on patient quality of life can range from minor annoyance to severe disability.

There are several well-recognized treatment strategies in existence, but single-day oral antiviral therapy for episodic treatment of recurrences is a new practice that has only recently been validated by several well-designed, large-scale clinical trials.

While there are no studies that directly compare the efficacy of different oral antivirals, available safety and efficacy data support famciclovir mg once a day or valacyclovir 2 g bid for 1 day in recurrent orolabial herpes as suitable first-line therapies for maximizing patient convenience and minimizing cost.

Likewise in recurrent genital herpes, famciclovir mg bid for 1 day appears to produce similar or better reductions in time to lesion healing and resolution of symptoms than the currently prescribed 2- to 5-day antiviral regimens.

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Additionally, single-day famciclovir is effective at preventing progression to a full genital herpes outbreak and is well-tolerated. These characteristics indicate single-day famciclovir to be appropriate as a first-line therapy.

Single-day treatment for recurrent orolabial and genital herpes introduces a high load of antiviral agent into the body during the time of maximal viral replication, limiting progression of disease. With single-day therapy, patients experience faster healing time, shorter duration of symptoms, while simultaneously regaining control over their disease through patient-initiated therapy.

Disclosures Dr. Tyring has conducted research and been a consultant for Novartis and GlaxoSmithKline.

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He has also received honoraria and grants from the same. National Center for Biotechnology Information , U. Ther Clin Risk Manag. Author information Copyright and License information Disclaimer. All rights reserved. This article has been cited by other articles in PMC. Abstract Herpes simplex virus HSV infection is a highly prevalent condition responsible for significant morbidity and occasional mortality each year.

Introduction Herpes simplex virus HSV causes an incurable viral infection that affects over 40 million people in the United States, with over , cases diagnosed each year Nadelman and Newcomer Mechanism of action Activation of acyclovir and penciclovir is dependent on viral thymidine kinase found in cells infected with herpesvirus.

Selectivity After absorption, penciclovir and acyclovir are taken up into both infected and uninfected cells. Discussion Treatment options for genital herpes Acyclovir was the first antiviral agent to be used in the treatment of genital herpes, and as such, is the most extensively studied of the antiviral agents currently available.

Oral agents The current standard of therapy is oral medication. Single-day treatment Based on the recent successes of high-dose acyclovir and valacyclovir regimens and the unique pharmacokinetic profile of famciclovir, an international, multicenter, randomized, double-blind, placebo-controlled trial was conducted to evaluate the efficacy of single-day famciclovir as a patient-initiated treatment for recurrent genital herpes in immunocompetent patients Aoki et al Table 1 Efficacy of single-day famciclovir compared to standard 2- to 5-day antiviral regimens in the treatment of recurrent genital herpes.

Antiviral agent Dosage regimen Duration of treatment Median time days to Percentage of aborted lesions Lesion healing Symptom resolution Famciclovir mg bid vs PL 1 1 day 4. Open in a separate window. PL, placebo. Comparison of therapies Although no head-to-head trials have compared single-day famciclovir to the currently prescribed 2- to 5-day antiviral regimens, it appears to produce similar or better reductions in time to lesion healing and resolution of symptoms Table 1.

Table 2 Comparison of retail cost 1 of standard dosing of antiviral agents. Drug prices and information [accessed 22 July ]. Treatment options for orolabial herpes Topical agents The first antiviral agents used for the treatment of recurrent orolabial herpes were formulated in creams.

Oral agents Compared to topical treatments, oral agents offer the benefit of less frequent dosing and increased bioavailability. Single-day treatments Famciclovir Oral famciclovir given as a single mg dose was FDA approved for the treatment of recurrent orolabial herpes in immunocompetent patients after the seminal work by Spruance and coworkers in Spruance et al Table 3 Efficacy of single-day famciclovir compared to single-day valacyclovir in the treatment of recurrent orolabial herpes.

Valacyclovir Rapidly absorbed and hydrolyzed into acyclovir and L-valine, valacyclovir has three to five times the bioavailability of traditional oral acyclovir Ormrod and Goa ; Spruance et al Comparison of therapies While clinical trials show that topical agents are efficacious, patients in the real world are unlikely to comply with the frequent dosing schedule required for optimal results, making oral antiviral agents the most convenient option for patient-initiated episodic therapy.

Conclusion Mucocutaneous infections caused by herpes simplex viruses in immunocompetent patients are usually self-limiting, although their impact on patient quality of life can range from minor annoyance to severe disability. Footnotes Disclosures Dr. Single-day, patient-iniated famciclovir therapy for recurrent genital herpes: Clin Infect Dis. Famciclovir, from the bench to the patient — a comprehensive review of preclinical data.

Int J Antimicrob Agents. Herpes simplex virus resistance to acyclovir and penciclovir after two decades of antiviral therapy. Clin Microb Rev. Valacyclovir for prevention of recurrent herpes labialis: Antiherpesvirus activity of 9- 4-hydroxyhydroxy-methylbutyl guanine BRL in cell culture. Antimicrob Agents Chemother. Famciclovir vs. Br J Dermatol.

Once-daily valacyclovir to reduce the risk of transmission of genital herpes. N Engl J Med. The pharmacological profile of famciclovir. Semin Dermatol. Oral famciclovir for the suppression of recurrent genital herpes: Herpes simplex virus 2 infection increases HIV acquisition in men and women: Oral antivirals for the acute treatment of recurrent herpes labialis. Ann Pharmacother. Genital herpes. Clin Evid. Mode of action, toxicity, pharmacokinetics, and efficacy of some new antiherpesvirus guanosine analogs related to buciclovir.