Acyclovir with and without Prednisone for the Treatment of Herpes Zoster

Whitley, Richard J.; Weiss, Heidi L.; Gnann, John W.; Sk, Tyring; Mertz, Grégory; Pappas, Peter G.; Schleupner, Charles J.; Hayden, Frederick G.; Wolf, John E.; Soong, Seng‐Jaw

doi:10.7326/0003-4819-125-5-199609010-00004

Cited by 342 publications

(98 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Corticosteroids-Randomized controlled trials of corticosteroids versus placebo or acyclovir with or without corticosteroids in older herpes zoster patients showed equal rates of PHN (20)(21)(22). These findings argue against the routine use of corticosteroids in older herpes zoster patients.…”

Section: Treatment Acute Herpes Zostermentioning

confidence: 44%

Herpes Zoster and Postherpetic Neuralgia in Older Adults

Schmader

2007

Clinics in Geriatric Medicine

View full text Add to dashboard Cite

SynopsisHerpes zoster afflicts millions of older adults annually worldwide and causes significant suffering due to acute and chronic pain, or postherpetic neuralgia (PHN). Herpes zoster is caused by the reactivation of varicella-zoster virus (VZV) in sensory ganglia in the setting of age, disease and drug-related decline in cellular immunity to VZV. VZV-induced neuronal destruction and inflammation causes the principal problems of pain, interference with activities of daily living and reduced quality of life in older adults. To address these problems, the optimal treatment of herpes zoster requires early antiviral therapy and careful pain management. For patients who develop PHN, evidence-based pharmacotherapy using topical lidocaine patch, gabapentin, pregabalin, tricyclic antidepressants, and/or opiates can reduce pain burden. The live attenuated zoster vaccine is effective in reducing pain burden and preventing herpes zoster and PHN in older adults. KeywordsHerpes zoster; varicella-zoster virus; postherpetic neuralgia; elderly; aged IntroductionHerpes zoster is a neurocutaneous disease that is caused by the reactivation of varicellazoster virus (VZV) from a latent infection of dorsal sensory or cranial nerve ganglia following primary infection with VZV earlier in life. VZV is a double-stranded DNA herpesvirus with a genome that contains at least 70 gene products (1). VZV expresses gene products and attempts replication throughout life but cellular immunity is critical to containing VZV. With aging-related decline in cellular immunity to VZV, the virus may escape cell-mediated immune containment and spread in the affected ganglia and sensory nerves to the skin.Address correspondence to Dr. Schmader at 182 GRECC, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA, telephone: 919-286-6932, fax: 919-286-6823, kenneth.schmader@duke.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscript EpidemiologyThe estimated incidence of herpes zoster in persons older than 65 years old varies from approximately 10 to 14 cases per 1000 per year (2-4). The lifetime incidence of herpes zoster is estimated to be about 20-30% in the general population and maybe as high as 50% among those surviving to 85 years or higher (5). Current population figures and herpes zoster incidence data yield estimates of about 1 million new cases of herpes zoster each year in the United States (6). The incidence of recurrent herpes zoster is not as well established but the frequency of recurrent events is hig...

show abstract

Section: Treatment Acute Herpes Zostermentioning

confidence: 44%

Herpes Zoster and Postherpetic Neuralgia in Older Adults

Schmader

2007

Clinics in Geriatric Medicine

View full text Add to dashboard Cite

show abstract

“…Randomized, double-blind trials comparing two different treatments for patients with PHN have supported this fact that nortriptyline is equivalent in efficacy to amitriptyline, but is better tolerated [25]. These drugs are best tolerated when they are started in a low dosage and given at bedtime.…”

Section: Tricyclic Antidepressants (Tcas)mentioning

confidence: 84%

The Current Treatment and Prevention of Post Herpetic Neuralgia

Ankit¹,

Zeng²,

Chen³

et al. 2018

View full text Add to dashboard Cite

Post herpetic neuralgia (PHN) is a chronic neuropathic pain syndrome in the area of the herpes zoster (HZ) rash, persisting after the cutaneous lesions have subsided. Despite numerous treatment advances, many patients remain refractory to the current therapies and continue to have pain, physical, economical and psychological distress. In this review, we will focus on the current treatment and prevention of PHN.

show abstract

“…It is estimated, on the basis of current US population figures and data on the age-specific incidence, that there are a million or more new cases of HZ each year in the United States, a number that is likely to increase as the population ages. Antiviral therapy does not eliminate the morbidity of HZ and PHN [4,9,15,19,20], and the neuropathic pain of PHN is often refractory to treatment [19]. Thus, a means of prevention would offer significant medical and economic benefit.…”

Section: Discussionmentioning

confidence: 99%

“…Antiviral therapy reduces the duration and severity of HZ, but it does not prevent PHN [4,9,14,15,[18][19][20]. PHN may persist for months or even years, and it is often refractory to treatment [19].…”

mentioning

confidence: 99%

Vaccination against Herpes Zoster and Postherpetic Neuralgia

Oxman¹,

Levin²

2008

J INFECT DIS

160

100

View full text Add to dashboard Cite

Background. Herpes zoster (HZ) and postherpetic neuralgia (PHN) cause significant morbidity in older adults. The incidence and severity of HZ and PHN increase with age in association with an age-related decline in varicellazoster virus (VZV)-specific cell-mediated immunity (VZV-CMI). VZV vaccines can boost VZV-CMI. Therefore, we tested the hypothesis that VZV vaccination would protect older adults against HZ and PHN.Methods. We enrolled 38,546 adults у60 years of age in a randomized, double-blind, placebo-controlled trial of an investigational HZ vaccine and actively followed subjects for the development of HZ. The primary end point was the burden of illness due to HZ (HZ BOI), a composite measure of the incidence, severity, and duration of pain and discomfort caused by HZ. The secondary end point was the incidence of PHN.Results. Subject retention was 195%. HZ vaccine reduced the HZ BOI by 61.1% (95% confidence interval [CI], 51.1%-69.1%;) and reduced the incidence of PHN by 66.5% (95% CI, 47.5%-79.2%; ). The P ! .001 P ! .001 incidence of HZ was also reduced by 51.3% (95% CI, 44.2%-57.6%;). HZ vaccine was well tolerated; P ! .001 injection site reactions were generally mild. HZ vaccine neither caused nor induced HZ.Conclusion. The Shingles Prevention Study demonstrated that HZ vaccine significantly reduced the morbidity due to HZ and PHN in older adults.

show abstract

Acyclovir with and without Prednisone for the Treatment of Herpes Zoster

Abstract: In relatively healthy persons older than 50 years of age who have localized herpes zoster, combined acyclovir and prednisone therapy can improve quality of life.

Cited by 342 publications

References 13 publications

Herpes Zoster and Postherpetic Neuralgia in Older Adults

Herpes Zoster and Postherpetic Neuralgia in Older Adults

The Current Treatment and Prevention of Post Herpetic Neuralgia

Vaccination against Herpes Zoster and Postherpetic Neuralgia

Contact Info

Product

Resources

About