Am J Perinatol. 1998 Jan;15(1):57-62.
Cost-effectiveness of acyclovir suppression to prevent recurrent genital herpes in term pregnancy.

Scott LL, Alexander J.

University of Texas Southwestern Medical School, Department of Obstetrics and Gynecology, Dallas 75235-9032, USA.

The objective of this paper is to determine whether acyclovir suppression provides a greater cost savings over no medical therapy in the management of recurrent genital herpes (HSV) in pregnancy. Estimates of the risk of HSV recurrence and cesarean delivery rates in acyclovir-treated and -untreated patients and frequency of neonatal acyclovir treatment were derived from literature reviews, prospective surveillance, and practices at our institution. Estimates of costs were derived from average hospital and outpatient clinic charges at our institution. Calculations were run separately for four different groups of patients: women whose first diagnosis of genital herpes occurred during the pregnancy, women whose diagnosis antedated pregnancy and who had infrequent recurrences, women whose diagnosis antedated pregnancy and had frequent recurrences, and all women with a history of genital herpes regardless of timing of diagnosis or frequency of recurrences. Suppressive acyclovir treatment of all term pregnant women with a history of genital herpes resulted in an estimated savings of $183.00 per patient or $36,600,000 per year. Women with their first episode of herpes diagnosed during pregnancy or with frequent recurrences benefitted even more, achieving a savings of $455.00 and $391.00 per patient, respectively. Assuming that prenatal acyclovir treatment is safe for the fetus, utilizing this management for all patients with recurrent HSV in pregnancy could immediately save $183 per patient. On a national level, this translates to $36,600,000 per year just in reduced obstetrical costs. If indirect costs associated with cesarean deliveries had been included in these calculations, the estimated savings would be even more substantial.

Online pharmacy ref source - acyclovir: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9475690&dopt=Abstract acyclovir Zovirax

mcmail.vanderbilt.edu

OBJECTIVE: Varicella-zoster virus has been reported to produce serious, often life-threatening, disease in immunosuppressed patients with a variety of diagnoses. The impact of this virus on the young child after heart transplantation has not been reported. METHODS: We reviewed the charts of 28 children who were <10 years of age at heart transplantation and had at least 1 year of follow-up. The median follow-up period was 7 years (1.4-13.0 years). All were seronegative for varicella-zoster virus before transplantation. Fourteen (50%) developed varicella at a median time posttransplantation of 3.3 years. The first 7 were admitted for intravenous acyclovir for 3 days followed by oral acyclovir for 7 days. The last 7 were treated as outpatients with oral valacyclovir for 7 days (n = 6) or with oral acyclovir for 10 days (n = 1). RESULTS: Intravenous and oral regimens both were well tolerated and were without complications. No patient was receiving steroids at the time that they developed their initial episode of varicella. One patient was receiving steroids for therapy of posttransplantation lymphoproliferative disease when she developed recurrent varicella or generalized zoster. No episodes of rejection were attributed to the varicella-zoster virus infection. There were no episodes of localized zoster. All patients experienced seroconversion from undetectable to detectable antibody titers early after varicella, and 12 of the 14 patients continued to have persistent detectable titers in late follow-up. Two of the 14 who received chemotherapy or enhanced immunosuppression after retransplantation transiently lost detectable varicella-zoster virus antibodies but currently have detectable titers. CONCLUSIONS: Primary varicella-zoster infection was well tolerated in our young pediatric heart transplant recipients, with no serious complications. We now reserve inpatient/intravenous therapy for those who are unable to tolerate oral medications or those who are receiving enhanced immunosuppression.

Online pharmacy ref source - acyclovir: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11694664&dopt=Abstract acyclovir Zovirax

pharmacy.ualberta.ca

PURPOSE: To design a buccal mucoadhesive system for systemic delivery of acyclovir using a novel mucoadhesive, copolymers of acrylic acid and poly(ethylene glycol), and to determine the feasibility of transbuccal delivery of acyclovir using this system. METHODS: The buccal delivery system was prepared using an adhesive, a copolymer of acrylic acid and poly(ethylene glycol) monomethylether monomethacrylate, and an impermeable membrane to prevent excessive washout by saliva and to attain unidirectional release. Acyclovir was loaded into the copolymer film prior to lamination of backing material. In vitro drug release studies were conducted in isotonic McIlvaine buffer solution. Buccal permeation of acyclovir was investigated using porcine buccal mucosa with side-by-side flow through diffusion cells at 37;C. Acyclovir was quantified using HPLC. RESULTS: Buccal permeation of acyclovir from the mucoadhesive delivery system was controlled for up to 20 hours with a time lag (t(lag)) of 10.4 hours and a steady state flux of 144.2 microg/cm(2)/h. With the incorporation of NaGC into the system t(lag) was shortened to 5.6 hours with an enhanced steady state flux of 758.7 microg/cm(2)/h. Sustained delivery of acyclovir across bucccal mucosa using this mucoadhesive system was maintained for up to 22 hours. CONCLUSIONS: The mucoadhesive system of P(AA-co-PEG) was shown to be a good candidate for controlled oral mucosal delivery of acyclovir. Buccal delivery of acyclovir was proven feasible based on in vitro permeation studies.

Online pharmacy ref source - acyclovir: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10945920&dopt=Abstract acyclovir Zovirax




Vestn Ross Akad Med Nauk. 1995;(9):12-5.
[Varying sensitivity to acyclovir of different years' clinical isolates of herpes simplex virus]

[Article in Russian]

Briazhikova TS, Isakov VA, Iurlova TI, Golovanova AK.

The population of types I and 2 herpes simplex viruses (HSV) to be studied consisted mainly of Acyclovir-sensitive strains. In some cases Acyclovir-resistant HSV strains were detected. The phenotypic profile of the Acyclovir-resistant strains were shown to have low reproduction rates in tissue cultures. Their antigenic character was similar to that of reference strains. Several phenotypic variants concurrently isolated from the same patient differ in their reproductive properties, antigenic characteristics, and sensitivity to Acyclovir. It is expedient to examine HSV isolates from patients for their sensitivity to chemicals used in clinical practice. This will allow patients with herpes infection to be treated on an individual basis.

Online pharmacy ref source - acyclovir: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7580404&dopt=Abstract acyclovir Zovirax




Antiviral Res. 1995 May;27(1-2):19-37.
Efficacy of traditional herbal medicines in combination with acyclovir against herpes simplex virus type 1 infection in vitro and in vivo.

Kurokawa M, Nagasaka K, Hirabayashi T, Uyama S, Sato H, Kageyama T, Kadota S, Ohyama H, Hozumi T, Namba T, et al.

Department of Virology, Toyama Medical and Pharmaceutical University, Japan.

Traditional herbal medicines have been safely used for the treatment of various human diseases since ancient China. We selected 10 herbal extracts with therapeutic antiherpes simplex virus type 1 (HSV-1) activity. Among these, Geum japonicum Thunb., Rhus javanica L., Syzygium aromaticum (L.) Merr. et Perry, or Terminalia chebula Retzus showed a stronger anti-HSV-1 activity in combination with acyclovir than the other herbal extracts in vitro. When acyclovir and/or a herbal extract were orally administered at doses corresponding to human use, each of the 4 combinations significantly limited the development of skin lesions and/or prolonged the mean survival times of infected mice compared with both acyclovir and the herbal extract alone (P < 0.01 or 0.05). These combinations were not toxic to mice. They reduced virus yields in the brain and skin more strongly than acyclovir alone and exhibited stronger anti-HSV-1 activity in the brain than in the skin, in contrast to acyclovir treatment by itself. Combinations of acyclovir with historically used herbal medicines showed strong combined therapeutic anti-HSV-1 activity in mice, especially reduction of virus yield in the brain.

Online pharmacy ref source - acyclovir: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7486956&dopt=Abstract acyclovir Zovirax