ANTIVIRAL DRUG TREATMENTS FOR RECURRENT HERPES LABIALIS

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ANTIVIRAL DRUGTREATMENTS FOR RECURRENT HERPES
LABIALIS GENITALIS IN THE HEALTHY ADULT
FRED Y AOKI, MD
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Objectives

• Appreciate the brief time to peak virus titres in
  recurrent herpes labialis genitalis lesions and
  the correspondingly brief window of opportunity
  to start therapy.
• Be reminded of 3 available antiviral drugs.
• Appreciate evolution of antiviral drug regimens
  for therapy.
• Be aware of most recent single day treatments

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Virus Concentration in Recurrent Cold Sores Peak
at 12 -24 Hr. After Onset
Spruance, NEJM 23769, 1997
Window of Opportunity to Treat with Antiviral
Drug Therapy is Short (lt 24 H)
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Virus Concentration in Recurrent Genital Herpes
Lesions Peak at Day 3 in Women Day 1 in Men
Brown West J Med 130414, 1979
Window of Opportunity to Treat with Antiviral
Drugs is Short (1 3 days)
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Antiviral Drugs Efficacious for the Treatment of
Recurrent Herpes labialis genitalis in
Randomized Controlled Trials

• For Recurrent Herpes labialis
• Episode Therapy
• Topical
• Penciclovir - Q2h x 4 days
• Docosanol - 5 times per day till healed
• Oral Agents
• Valacyclovir - twice in 1 day
• Famciclovir one dose

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• I.B. Suppressive Therapy
• Acyclovir
• Valacyclovir
• Prophylactic Before Known Trigger
• Acyclovir before trigeminal nerve surgery
• Acyclovir before sun exposure

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• For Recurrent Herpes genitalis
• Episode Therapy
• Acyclovir for 5 days
• Valacyclovir for 3 days
• Acyclovir for 2 days
• Famciclovir single day
• Suppressive Therapy
• All 3 drugs efficacious

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Single Day Treatments for Episodes of Recurrent
Herpes labialis

• For Recurrent Herpes labialis
• Valacyclovir 2 g twice in 1 day
• Famciclovir 1.5 g once or 750 mg twice
• For Recurrent Genital herpes
• Famciclovir 1 g twice

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Famciclovir 1 g Twice in 1 day Compared to
Placebo Started at lt 6 Hr. After Onset

• Doubled aborted lesions from 13 to 23
• Shortened mean healing time by 2 days from 6.1
  4.3 days
• Caused more headache (14 vs 5)
• Aoki, JCID 428, 2006

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To make Single-day Therapy of Recurrent Herpes
labialis genitalis Effective

• Provide prescription to be filled.
• Tell patient to carry first dose on person at all
  times.
• Educate patient to enable initiation of therapy
  at lt 6 h.