Prophylactic Oral Acyclovir Research Articles

Long term outcome of Tenon's patch graft in corneal perforation secondary to neurotrophic keratitis: A case report on a 4-year anatomical functional outcome.

IntroductionThis report describes the long-term outcomes of Tenon’s patch graft (TPG) in a corneal perforation secondary to neurotrophic keratitis and outcome of subsequent successful cataract surgery.Presentation of the caseA 60-year gentleman presented with a corneal perforation secondary to Herpes Zoster ophthalmicus (HZO). After multiple unsuccessful attempts of cyanoacrylate tissue adhesive application over the perforation, he was referred for a corneal patch graft. Following TPG, he had a tectonically stable cornea that was managed with topical steroids and prophylactic oral Acyclovir. Sequential imaging of the cornea using high-resolution anterior segment- optical coherence tomography (HR-ASOCT) was done to monitor wound healing. Fifteen months later, he underwent uneventful cataract surgery with best-corrected visual acuity improving to 20/30 at 1-month.DiscussionSerial imaging of the site of perforation with HR-ASOCT revealed that a fluffy, oedematous TPG in the early postoperative period transitioned into a hyper-reflective, thin, and compact graft over 3-4 months. Despite the corneal thickness at the site of perforation being only 142 μm, the wound had adequate tensile strength to withstand the altered anterior chamber dynamics during phacoemulsification. The resultant translucent nature of the scar provided superior media clarity and better visual outcomes.ConclusionThis case demonstrates the efficacy of TPG in acute phase management of corneal perforation following HZO thereby restoring the tensile strength of the cornea, enabling it to withstand the stress of future surgeries like phacoemulsification.

Long-term outcomes of penetrating keratoplasty for corneal complications of herpes zoster ophthalmicus

Background/AimTo review the long-term outcomes of penetrating keratoplasty (PKP) for corneal complications of herpes zoster ophthalmicus (HZO).MethodsWe reviewed the medical records of 53 eyes of 53 patients who underwent PKP...

Clinical features and prognosis of herpetic anterior uveitis: a retrospective study of 111 cases

To describe the clinical features and outcomes in patients with herpetic anterior uveitis. We reviewed the records of 111 patients with a clinical diagnosis of herpetic anterior uveitis seen at the Department of Ophthalmology, Istanbul Faculty of Medicine, from January 1996 to December 2006. Demographic and clinical features, recurrence rate, and visual outcome were analyzed. Fifty patients were male, 61 were female. Mean age at presentation was 39.2 ± 16.5 (6-74) years. Three atopic patients had bilateral involvement. Twelve patients had active or a past episode of herpes zoster ophthalmicus. Ocular findings were granulamatous anterior uveitis (93%), active keratitis or corneal scars (57%), elevated intraocular pressure (51%), iris atrophy (48%), distorted pupil (25%), and posterior synechiae (26%). Secondary glaucoma developed in two patients. None of the patients had posterior segment complications. The recurrence rate was 0.45/person-year. Topical corticosteroids and oral antiviral therapy were administered to all patients during active episodes. Long-term prophylactic oral acyclovir was used in 13%. Final visual acuity was worse than 0.5 in 17% of the involved eyes and was due to corneal scarring or cataract formation. Patients with iridocyclitis only had no permanent visual loss. Herpetic anterior uveitis is a recurrent granulomatous disease commonly associated with corneal involvement, iris atrophy, and transient intraocular pressure rise. Visual prognosis is good, especially in patients who have only anterior uveitis without corneal disease.

Comparison of oral antiviral therapy with valacyclovir or acyclovir after penetrating keratoplasty for herpetic keratitis

Aims:To compare the outcome of prophylactic oral valacyclovir (VAL) or oral acyclovir treatment (ACV) in patients having undergone penetrating keratoplasty for herpetic keratitis (HK).Methods:All patients having received a penetrating keratoplasty...

Effect of Cytomegalovirus Prophylaxis with Acyclovir on Renal Transplant Survival

It is recognized that cytomegalovirus (CMV) infection in transplant recipients may lead to graft loss. Prophylaxis with acyclovir has therefore gained widespread acceptance, but the debate on whether this intervention improves long term graft survival continues. All patients who received renal grafts at the National Renal Transplant Centre, Dublin, between January 1992 and December 1999 were retrospectively analyzed. During this time period, patients who were CMV positive and/or had received grafts from CMV-positive donors were administered prophylactic oral acyclovir 800 mg thrice daily, adjusted for calculated creatinine clearance, from the first day post-transplantation. This treatment was continued for three months unless the graft failed or the patient developed CMV disease or died. Graft and patient outcomes were compared in recipients who received acyclovir with those who did not. Over the study period, 935 patients received renal transplants in our center, of whom 487 were administered acyclovir. The incidence of CMV disease was 3.3 cases per 100 patients per annum in those who required prophylaxis. Despite prophylaxis, graft outcomes were found to be significantly worse (p value < 0.001) in the group that qualified for acyclovir. We conclude that acyclovir provides incomplete protection from the negative impact of CMV on graft survival.

Effect of Prophylactic Oral Acyclovir After Penetrating Keratoplasty for Herpes Simplex Keratitis

To determine the effect of routine use of prophylactic oral acyclovir after penetrating keratoplasty (PK) for herpes simplex virus (HSV) keratitis on recurrence, rejection, and graft failure rates. Records from 70 consecutive patients who underwent PK for HSV keratitis at the W.K. Kellogg Eye Center between August 1, 1990, and December 31, 2000, were reviewed. Data collected included preoperative disease activity, duration, host vascularity, pre- and postoperative vision, and antiviral use. Particular attention was given to all episodes of HSV recurrence, graft rejection, and failure. Fifty-six patients (80%) were treated with prophylactic oral acyclovir after surgery. This cohort experienced fewer episodes of rejection (P = 0.006) and better overall graft survival (P = 0.04) than those who were not treated with prophylactic oral antivirals. There was no statistically significant difference in recurrence-free survival between the 2 groups (P = 0.22). Cox regression analysis failed to identify any single variable as a statistically significant predictor of recurrence, rejection, or graft failure. Prophylactic oral acyclovir use after PK for HSV keratitis is associated with decreased episodes of rejection and improved graft survival.

Herpes Simplex Virus (HSV)-1 and -2, and Varicella Zoster Virus (VZV)

Herpes Simplex Virus (HSV)-1 and -2, and Varicella Zoster Virus (VZV)

Efficacy of low-dose and long-term oral acyclovir therapy after penetrating keratoplasty for herpes simplex heratitis

PURPOSE: To evaluate the efficacy of long-term and low-dose prophylactic oral acyclovir therapy in preventing the recurrence of herpetic infection and increasing graft survival in patients who undergo penetrating keratoplasty (PK) for herpes simplex keratitis (HSK). Patients and methods : Nineteen patients were included in the study, who underwent PK for herpes keratitis from July 1993 to November 1995, received oral acyclovir, and were followed at least 12 months. Group 1 included 12 patients with corneal scarring without perforation. These patients were free of inflammation for a mean of 4.1±2.2 months preoperatively, and received oral acyclovir 400 mg/day postoperatively for one year. Seven patients (Group 2) who developed corneal perforation due to necrotizing keratitis were treated with tissue adhesives, therapeutic contact lenses, and topical antiviral and oral acyclovir therapy for the resolution of active inflammation followed by PK after a mean of 3.8±2.1 months follow-up. They received oral acyclovir 400 mg/day postoperatively for one year in addition to standard postoperative therapy. The control group consisted of 16 patients (Groups 3 and 4) who underwent PK for herpes simplex keratitis and did not receive oral acyclovir. The indication for PK was corneal opacity and impaired visual acuity in 12 patients (Group 3) and corneal perforation in four (Group 4). RESULTS: After an average of 25 months follow-up, there was only one recurrence (8.3%) in Group 1 and two cases (28.6%) of herpetic recurrence in Group 2. Recurrence occurred at two months in one patient while he was taking oral acyclovir. Two of these recurrences followed the withdrawal of oral acyclovir therapy after one year of therapy. In contrast, in control groups there were four cases of herpetic recurrence (33.3%) in Group 3 and two (50%) in Group 4 after a mean of 30.5 months postoperative follow-up. In the study groups, a rejection episode was seen in three patients (15.8%) which was successfully treated with medical therapy. One patient from Group 2 developed bacterial keratitis which subsequently resulted in graft failure. All grafts remained clear in the other patients (94.7%). In the control groups, rejection developed in seven patients. Three rejection episodes were treated successfully. The other four developed graft failure in spite of intensive medical therapy. CONCLUSIONS: Our results suggest that postoperative oral acyclovir therapy is effective in preventing the recurrence of herpetic infection. However, the recurrence may develop after cessation of oral acyclovir therapy, especially in patients who underwent PK for corneal perforation due necrotizing HSK.

Prophylactic oral ganciclovir compared with deferred therapy for control of cytomegalovirus in renal transplant recipients.

Treatment with prophylactic oral acyclovir, intravenous ganciclovir, or immunoglobulins to prevent cytomegalovirus (CMV) infection and disease in renal transplantation is associated with variable efficacy and significant expense. We studied control of CMV in renal transplant recipients using either prophylactic oral ganciclovir or deferred therapy with intensive monitoring with polymerase chain reaction (PCR) analysis. Forty-two recipients were followed for 6 months after transplantation. Ganciclovir (1000 mg p.o. t.i.d.; n=19) or acyclovir (200 mg p.o. b.i.d.; n=23) was begun at transplantation and continued for 12 weeks. PCR for CMV was performed on buffy-coat specimens every week for 15 weeks and at months 5 and 6. No patients in the ganciclovir group, compared with 14 of 23 patients (61%) in the deferred-therapy group (P<0.0001), developed CMV disease during the first 12 weeks. In the ganciclovir group, 4 of 19 patients (21%) subsequently experienced 5 episodes, whereas 14 patients in the deferred-therapy group experienced 18 episodes (P=0.013 for subjects and P=0.026 for episodes). The time to disease was also delayed in the ganciclovir group compared with the deferred-therapy group (133+/-17 days vs. 51+/-7 days; P<0.0001). Oral ganciclovir also prevented CMV viremia during prophylaxis (2/19 patients [11%] vs. 23/23 patients [100%]). Time to CMV viremia was delayed in the ganciclovir group; however, 13/19 patients (68%) ultimately showed PCR evidence for CMV viremia (P=0.005). An initial 12-week course of oral ganciclovir prevents CMV disease and infection in renal transplant recipients during prophylaxis, and the benefits persist after discontinuation.

Antiviral Therapy After Penetrating Keratoplasty for Herpes Simplex Keratitis

To assess the efficacy of prophylactic topical antiviral therapy after penetrating keratoplasty for herpes simplex keratitis in the postoperative period and during the treatment of allograft rejection episodes with topical steroids. We used these data to make predictions of the sample size required to perform a prospective study of prophylactic oral acyclovir in the postoperative period. Retrospective review. A university referral cornea service. One hundred thirty-two consecutive penetrating keratoplasties for herpes simplex keratitis in 119 eyes of 118 patients. Only four grafts were performed in actively inflamed eyes. Sixty-six (52%) of the grafts performed in quiescent eyes received prophylactic postoperative topical antiviral treatment, three (2%) received oral acyclovir, and 59 (46%) received no antiviral therapy. The mean (+/- SD) duration of antiviral therapy was 12.8 +/- 22.5 months. Herpetic recurrence, allograft rejection episodes, and graft failure. Multivariate analysis showed that early antiviral use was associated with a decreased risk of herpes simplex keratitis recurrence (relative risk [RR] = 0.44; 95% confidence interval [CI], 0.21 to 0.94; P = .007) and allograft rejection (RR = 0.43; 95% CI, 0.25 to 0.75; P = .002). Graft failure was associated with herpetic recurrence within the first year (RR = 2.25; 95% CI, 1.09 to 4.64; P = .001) and allograft rejection episodes (RR = 2.56; 95% CI, 1.20 to 5.26; P = .003). Using these data, a prospective trial of postoperative oral acyclovir would require between 59 and 112 patients per group. Postoperative prophylactic antiviral treatment is associated with decreased rates of herpes simplex viral keratitis recurrence and allograft rejection. Early recurrence is associated with an increased risk of graft failure. A prospective study of postoperative oral acyclovir would require a multicentered approach.

Herpes simplex esophagitis after renal transplantation.

This paper describes five renal transplant recipients, out of a series of 221 consecutive patients, who developed herpes simplex esophagitis. This opportunistic infection presented as odyno- and/or dysphagia. It occurred during or shortly after treatment of acute cellular rejection episodes with high doses of steroids and, in four cases, of anti-lymphocyte globulins. The infection responded to acyclovir in all patients. We conclude from these observations that herpes esophagitis occurs during periods of intensive immunosuppression. Because its endoscopic manifestations are variable, biopsies and cultures are essential to reach the diagnosis. Prevention may be possible by avoiding transplantation from a seropositive donor to a negative recipient and by prophylactic oral acyclovir.

Prophylactic Oral Acyclovir in Outbreaks of Primary Herpes Simplex Virus Type 1 Infection in a Closed Community

Oral acyclovir was given prophylactically to 37 children in the early stages of three outbreaks of herpes simplex virus type 1 (HSV-1) infection and the results were compared with those in untreated control subjects in two other outbreaks. The rates of seroconversion to HSV were significantly reduced in children treated with acyclovir compared with control subjects (91% vs 27%, P less than .001). The incidence of symptomatic disease was also significantly reduced (82% vs 0%, P less than .001). In some children receiving prophylactic acyclovir, anti-HSV antibody titers did not rise despite the presence of replicative HSV on throat swabs just before the start of treatment. Restriction endonuclease analysis of isolated HSV-DNA confirmed that one strain was responsible for the five outbreaks. No resistance to acyclovir was detected during the study, and no adverse effects of treatment were noted. In conclusion, short-term prophylactic acyclovir may limit the spread and reduce clinical manifestations of HSV infections in closed communities, although this use should be restricted to communities where severe symptoms are observed.

Opportunistic infections in children following renal transplantation

Opportunistic infections following renal transplantation in children are a major cause of severe morbidity and mortality. These infections account for the majority of early post renal-transplant deaths in children. General risk factors which affect the incidence and severity of these infections include: transmission of the infectious agent by the donor organ; history of immunity in the recipient prior to transplantation; type and amount of immunosuppression including treatment for rejection episodes; availability of specific treatment for the infection. Children are at particular risk because of the lack of exposure to certain pathogens prior to transplantation. There have been recent advances in the prevention and treatment of important infections which occur in children following transplantation, including varicella, Pneumocystis carinii pneumonia (PCP) and cytomegalovirus (CMV) disease. Varicella is treatable with acyclovir, often without decreasing immunosuppression and placing the graft at risk. Prophylaxis against PCP may be achieved by provision of alternate-day trimethoprim sulpha, but clear guidelines for determining who should be treated are lacking. Treatment of this disease with high-dose trimethoprim sulfa or pentamidine is usually successful. CMV disease is frequently severe, especially when the donor is seropositive and the recipient seronegative. In these situations, prophylactic CMV immunoglobulin reduces the morbidity and the mortality of the disease and prophylactic oral acyclovir may decrease its incidence. Treatment of severe CMV disease with gancyclovir is promising.

Acyclovir. An updated review of its antiviral activity, pharmacokinetic properties and therapeutic efficacy.

Acyclovir (aciclovir) is a nucleoside antiviral drug with antiviral activity in vitro against members of the herpes group of DNA viruses. As an established treatment of herpes simplex infection, intravenous, oral and to a lesser extent topical formulations of acyclovir provide significant therapeutic benefit in genital herpes simplex and recurrent orofacial herpes simplex. The effect of acyclovir therapy is maximised by early initiation of treatment, especially in non-primary infection which tends to have a less protracted course than the primary episode. Long term prophylactic oral acyclovir, in patients with frequent episodes of genital herpes simplex, totally suppresses recurrences in the majority of subjects; as with other infections responding to acyclovir, viral latency is not eradicated and pretreatment frequencies of recurrence return after discontinuation of treatment. Caution should accompany the prophylactic use of acyclovir in the general population, due to the theoretical risk of the emergence of viral strains resistant to acyclovir and other agents whose mechanism of action is dependent on viral thymidine kinase. Intravenous acyclovir is the treatment of choice in biopsy-proven herpes simplex encephalitis in adults, and has also been successful in the treatment of disseminated herpes simplex in pregnancy and herpes neonatorium. Intravenous and oral acyclovir protect against dissemination and progression of varicella zoster virus infection, but do not protect against post-herpetic neuralgia. In immunocompromised patients, intravenous, oral and topical acyclovir shorten the clinical course of herpes simplex infections while prophylaxis with oral or intravenous dosage forms suppresses reactivation of infection during the period of drug administration. Ophthalmic application of 3% acyclovir ointment rapidly heals herpetic dendritic corneal ulcers and superficial herpetic keratitis. Thus, despite an inability to eradicate latent virus, acyclovir administered in therapeutic or prophylactic fashion is now the standard antiviral therapy in several manifestations of herpes simplex virus infection, and indeed represents a major advance in this regard. With the exception of varicella zoster virus infections, early optimism concerning the use of the drug in diseases due to other herpes viruses has generally not been supported in clinical investigations.

Suppression of recurrent non-genital herpes simplex infection by prophylactic oral acyclovir

Following a primary infection with herpes simplex virus (HSV) some patients proceed to suffer repeated recurrences of the HSV infection. Whilst it has recently been shown that oral acyclovir taken prophylactically decreases the frequency of recurrent genital HSV infection (Douglas et al., 1984; Mindel et al., 1984; Straus et al., 1984), to date there have been no reports of any form of effective prophylaxis against recurrent HSV infection on non-genital skin in immunocompetent patients. In order to determine if oral acyclovir could afford protection in such patients we have performed a double-blind, placebo-controlled, crossover trial of oral acyclovir in patients experiencing eight or more episodes of recurrent non-genital HSV infection per year. Fourteen patients entered the trial and 11 completed the protocol. Only two patients experienced a recurrence during the 12-week treatment period with acyclovir (200 mg four times daily), compared with nine during placebo treatment (P= 0016, sign test). Although lesion development was effectively suppressed in nine of the patients whilst taking acyclovir, the development of prodromal symptoms and occasionally erythema was reported by five. There was no difference between acyclovir and placebo in the time to first recurrence following completion of treatment. No patient reported any side-effects of either placebo or acyclovir therapy. It is believed that this is the first report of any form of therapy which is effective in the suppression of the frequently recurring non-genital HSV infection in immunocompetent patients.

Post-Herpetic Erythema Multiforme Prevented with Prophylactic Oral Acyclovir

Brief Reports1 May 1985Post-Herpetic Erythema Multiforme Prevented with Prophylactic Oral AcyclovirJON A. GREEN, M.D., Ph.D., SPOTSWOOD L. SPRUANCE, M.D., GAY WENERSTROM, R.N., MICHAEL W. PIEPKORN, M.D., Ph.D.JON A. GREEN, M.D., Ph.D.Search for more papers by this author, SPOTSWOOD L. SPRUANCE, M.D.Search for more papers by this author, GAY WENERSTROM, R.N.Search for more papers by this author, MICHAEL W. PIEPKORN, M.D., Ph.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-102-5-632 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptRecurrent herpes simplex virus infection predisposes to the development of erythema multiforme in some persons (1) and can lead to a pattern of recurrent erythema multiforme and disabling morbidity. Recent reports of the safety and efficacy of oral acyclovir for the prophylaxis of recurrent herpes virus infections (2-4) suggest a similar application for the prevention of herpes virusrelated erythema multiforme.A 26-year-old white man, a professional housepainter, had recurrent labial herpes virus infections for 12 years with a stable pattern of three to five episodes a year. At age 24 he began having accelerated recurrences at monthly or bimonthly intervals....

PROPHYLACTIC ORAL ACYCLOVIR IN RECURRENT GENITAL HERPES

56 patients with frequently recurring genital herpes were treated in a randomised double-blind trial with either oral acyclovir 200 mg four times a day or placebo for 12 weeks. 29 patients received the drug and 27 the placebo. The mean recurrence rate per month of treatment was 1·4 in the placebo-treated patients and 0·05 in the acyclovir group. Median time to the first recurrence after the start of therapy was 14 days in the placebo group compared with 100 days in the acyclovir group. After the end of treatment the recurrence rate was similar in the two groups. Prophylactic oral acyclovir seems to be an effective treatment for patients with frequently recurring genital herpes.

Treatment and prevention of herpes genital infection

The recent introduction of acyclovir for the treatment of genital herpes offers new hope for sufferers of this troublesome and recurrent condition. The results of the published trials with acyclovir in both primary and recurrent genital herpes are reviewed. The results show that acyclovir is a useful drug for the treatment of primary infections, but has a limited role in treating recurrences. Preliminary results with prophylactic oral acyclovir suggest that this form of therapy may be useful in patients with frequent severe recurrences.