Clin Infect Dis. 1998 Mar;26(3):659-63.
Perspectives on switching oral acyclovir from prescription to over-the-counter status: report of a consensus panel.

Sande MA, Armstrong D, Corey L, Drew WL, Gilbert D, Moellering RC Jr, Smith LG.

Department of Internal Medicine, University of Utah, Salt Lake City 84132, USA.

The proposed switching of oral acyclovir from prescription to over-the-counter (OTC) status for the 5-day episodic treatment of genital herpes was considered by a consensus panel. It was concluded that self-diagnosis/misdiagnosis, misuse, and adverse drug effects were potential problems with the OTC use of acyclovir. While acyclovir reduces asymptomatic shedding of herpes simplex virus type 2, the reduction in transmission of virus potentially resulting from increased acyclovir use was felt to be of unknown extent but likely to be of benefit overall. The availability of acyclovir would likely be improved. There were differences in opinion as to whether widespread availability of acyclovir (prescription or OTC) may speed the development of viral resistance. However, all panel members felt that granting OTC status may set an undesirable precedent for the switch from prescription to OTC use of other systemically administered antiinfective agents. The effect of this precedent, in terms of accelerating development of multidrug-resistant bacteria, was a major concern of all panel members. The consensus was that the switch of acyclovir to OTC status could not be supported.

Online pharmacy ref source - acyclovir: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9524840&dopt=Abstract acyclovir Zovirax




Nihon Kyobu Shikkan Gakkai Zasshi. 1995 Jul;33(7):728-32.
[Acyclovir and guinea-pig airway smooth muscle]

[Article in Japanese]

Nasuhara Y, Munakata M, Homma Y, Kawakami Y.

First Department of Medicine, School of Medicine, Hokkaido University, Sapporo, Japan.

Acyclovir, an anti-herpes virus drug, has been reported to affect aspirin-induced asthma (AIA). Acyclovir was reported to decrease the sensitivity to aspirin in some AIA patients. Although the hypothesis that AIA is related to viral infection has been stated, there is no proof that patients with AIA are infected with a specific virus. Therefore, whether the effect of acyclovir on AIA is due to an antiviral effect is not clear. We hypothesized that acyclovir directly affects airway smooth muscle. To test this hypothesis, we examined whether acyclovir can directly contract or relax guinea-pig airway strips, and whether it can modify contraction or relaxation induced with several agents in vitro. Acyclovir did not directly affect basal smooth muscle tone and did not affect the responses to leukotriene D4, prostaglandin E2, carbachol, or KCl. We conclude that acyclovir has no direct effect on the function of guinea-pig airway smooth muscle.

Online pharmacy ref source - acyclovir: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7563998&dopt=Abstract acyclovir Zovirax




J Infect Dis. 1994 Jun;169(6):1338-41.
Recurrence and resistance patterns of herpes simplex virus following cessation of > or = 6 years of chronic suppression with acyclovir. Acyclovir Study Group.

Fife KH, Crumpacker CS, Mertz GJ, Hill EL, Boone GS.

Department of Medicine, Indiana University School of Medicine, Indianapolis 46202-5124.

Questions have arisen regarding the clinical outcome and the possible selection of resistant virus when patients with genital herpes discontinue prolonged chronic acyclovir; 239 immunocompetent patients with a history of frequently recurring genital herpes who stopped successful suppressive therapy after 6 years were studied. Of the patients, 85.8% had at least one recurrence and 75% had at least two recurrences in the subsequent year (median time to first and second recurrence, 68 and 180 days, respectively). Herpes simplex virus isolates recovered from these patients had a median acyclovir sensitivity of 0.79 micrograms/mL and 4 (3.5%) were resistant (> or = 3 micrograms/mL). These values are comparable to those of pretherapy isolates and to reported values of isolates from acyclovir-naive patients. Also, paired pre- and posttherapy isolates from 13 patients showed no trend toward development of resistance. Thus, even after 6 years of acyclovir suppression, most patients continue to have recurrences, but the selection of resistant virus has not been observed.

Online pharmacy ref source - acyclovir: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8195614&dopt=Abstract acyclovir Zovirax




Antimicrob Agents Chemother. 1993 Oct;37(10):2241-3.
In vitro activity of penciclovir against clinical isolates of acyclovir-resistant and foscarnet-resistant herpes simplex virus.

Safrin S, Phan L.

Department of Medicine, University of California-San Francisco.

We tested 23 clinical isolates of acyclovir-susceptible, acyclovir-resistant, and foscarnet-resistant herpes simplex virus for susceptibility to penciclovir. Isolates showed cross-resistance to penciclovir and acyclovir, but penciclovir retained a relative activity against foscarnet-resistant isolates. Its clinical utility for the treatment of resistant herpes simplex virus infections remains to be studied.

Online pharmacy ref source - acyclovir: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8257152&dopt=Abstract acyclovir Zovirax




Arch Ophthalmol. 1994 May;112(5):601-7.
Antiviral therapy after penetrating keratoplasty for herpes simplex keratitis.

Moyes AL, Sugar A, Musch DC, Barnes RD.

W. K. Kellogg Eye Center, Department of Ophthalmology, Ann Arbor.

OBJECTIVE: 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. DESIGN: Retrospective review. SETTING: A university referral cornea service. PATIENTS: 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. INTERVENTIONS: 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. MAIN OUTCOME MEASURES: Herpetic recurrence, allograft rejection episodes, and graft failure. RESULTS: 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. CONCLUSIONS: 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.

Online pharmacy ref source - acyclovir: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8185515&dopt=Abstract acyclovir Zovirax