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The drug known by its generic name, Acyclovir, belongs to the synthetic nucleoside analogues group of drugs used primarily to treat particular viral infections. Manufactured by GlaxoSmithKline and marketed as Zovirax, it comes in liquid, capsule and tablet forms.
But acyclovir remains the oldest form of treatment for the herpes simplex 1 and simplex 2 viruses, or cold sores and genital herpes, which cause infections in those afflicted with HIV.
When a virus takes over a living cell and reproduces itself, at the host cell’s expense, acyclovir is converted into an activated form by the same virus, enabling it to use acyclovir’s active form instead of the nucleoside which it normally uses in the manufacture of DNA; DNA is a crucial element in the replication of a virus.
Simply put, cells which have been virally infected tend to absorb more of the acyclovir than their normal counterparts; therefore there is more conversion of it into active forms, a condition which helps prolong the anti-viral activity.
Acyclovir is not a curative treatment for viral infections but it can shorten the duration of the infections and lessen their possibility of developing into more serious medical conditions. In initial cases of genital herpes, acyclovir helps reduce lesions and decreases severity and frequency of infections which are recurrent.
Depending on the severity of the genital herpes infection of an individual who has it for the first time, an oral dosage of acyclovir at 400mg thrice a day has been recommended by the CDCP or Center for Disease Control and Prevention; this dosage has to be ingested between seven and ten days. The patient may then choose to have daily or episodic therapy; the former is also known as suppressive therapy. Patients who have existing conditions of HIV should take 400mg of oral acyclovir thrice a day between five and ten days.
While there haven’t been sufficient clinical studies on the use of acyclovir by pregnant women and subsequent adverse effects, nursing women are cautioned against ingesting acyclovir since this can be transferred to an infant as an excretion in breast milk.
All prices provided on this website are estimates only and will vary depending on your insurance and location. What is a system of tubes that plants use to transport water minerals and food throughout the plant? What was the chilling name given to the German plan to systematically eradicate Jews worldwide? Treatment for herpes simplex virus infections of the skin and mucous membranes including initial and recurrent genital herpes.
Treatment of primary herpes simplex infections, including genital herpes: 200 mg five times daily (usually every 4 hours while awake) for 5 to 10 days. Severely immunocompromised patients or those with impaired absorption: 400 mg five times daily for 5 days.
Prophylaxis of herpes simplex in immunocompromised patients: 200 to 400 mg four times daily. Chronic suppressive treatment: is not suitable for mild or infrequent recurrences of herpes simplex.
Administration in renal impairment: Doses of acyclovir should be reduced in renal impairment according to creatinine clearance (CC).
Acyclovir is contraindicated for patients who develop hypersensitivity to acyclovir or valacyclovir. Occasional adverse effects after systemic administration include increased serum bilirubin and liver enzymes, haematological changes, skin rashes (including erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis), fever, headache, dizziness and gastrointestinal effects such as nausea, vomiting and diadiarrhoea.
Top of pageAbstractA 35-yr-old, immunocompetent male was admitted complaining of severe odynophagia.
Top of pageIntroductionHerpes simplex esophagitis usually occurs in immunocompromised or severely debilitated patients. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics.


Acyclovir is a prescriptive medication that prevents the division and multiplication of viruses responsible for said infections. When the active acyclovir is incorporated into a new virus in the DNA, production of DNA stops. Taking acyclovir for treatment of genital herpes can help reduce its severity or prevent it from further recurrences. The latter is experienced as a painful rash which could develop several years after having had chicken pox with the reactivation of the virus. For shingles, acyclovir helps reduce pain, shorten the duration for healing, and halts the formation of more lesions and further spread of the virus.
Acyclovir may be used intravenously for patients who have severe cases of genital herpes as well as those whose immune systems are compromised.
Those who elected episodic therapy can choose to take acyclovir orally at 400mg thrice daily for a total of five days, 800mg thrice daily for a total of two days or 800mg twice a day for a total of five days.
For suppressive therapy, the CDCP recommends 400mg of oral acyclovir twice daily; those who are already infected with HIV should take it between 400mg and 800mg two or three times daily.
There have  not been any reported cases where Acyclovir would cause the patient  to fail a drug test. In such cases episodic treatment of recurrences may be more beneficial; a dose of 200 mg five times daily for 5 days has been recommended, preferably initiated during the prodromal period. Acyclovir should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
However, it has also been well documented that esophagitis may occasionally occur as an acute, self-limited illness in immunocompetent patients (1, 2, 3, 4, 5). FDA (Food and Drug Administration) approved the drug for use against the virus known as varicella-zoster in the treatment of viral infections which caused shingles and chicken pox. A study published last year, however, revealed that herpes strains which are resistant to acyclovir could develop over a certain period of time. Aside from acyclovir’s availability in 200 mg capsules, 400mg and 800mg tablets, and 200mg and 5ml liquid suspension, it is also available as a 50mg or 40ml injection, a 500mg and 1000mg powder and as 5% ointment.
There have been reports of seizures, hepatitis, agitation, hypersensitivity reaction, muscle pain, and anemia, all of which must be reported to the patient’s doctor for advisement.
Acyclovir (ACV) therapy is a well established treatment for immunocompromised or severely debilitated patients (6, 7).
Doctors have also prescribed acyclovir in the treatment of the Epstein-Barr virus which causes mononucleosis. However, ACV therapy in immunocompetent adults with esophagitis has been reported in only a few patients (2, 3, 4, 8, 9, 10).
Acyclovir therapy in immunocompetent adults with esophagitis has been described in only a handful of cases in the literature, although the therapy is well established in immunocompromised patients.
We herein present an immunocompetent patient with herpes simplex esophagitis whose symptoms were dramatically resolved after ACV therapy, and we discuss the value of the treatment.Top of pageCase reportA 35-yr-old male office worker was admitted to our hospital complaining of odynophagia of 5 days duration with progression to the stage at which even swallowing his own saliva produced severe retrosternal pain.
The patient had had a low grade fever and malaise for 3 days before the development of odynophagia. Herpes simplex esophagitis in the immunocompetent patients: Report of four cases and review. Acyclovir therapy may be beneficial in immunocompetent patients with particularly severe odynophagia.
The past history was totally noncontributory, with the patient specifically denying heartburn, odynophagia, and mucosal or skin vesicles or ulcers.


Herpes esophagitis in immunocompetent adults: Report of two cases and review of the literature. Esophageal ulceration in human immunodeficiency virus infection: Causes, response to therapy, and long-term outcome. Esophagoscopy on admission revealed multiple punched-out ulcers, which became partially confluent in appearance, like a map, in the distal third of the esophagus (Fig. He was able to eat solid food, including toast, on day 7, and he was discharged from the hospital on the day 10. The follow-up esophagoscopy 4 days after discharge showed no lesions except for ulcer scars in the middle and distal thirds.
The ulcers become partially confluent in appearance, like a map.Full figure and legend (170K)The histology of the biopsy specimen on the day of admission obtained from the edge of the ulcers showed the squamous epithelium in acute and chronic inflammation without evidence of viral inclusions and pseudohyphae. Immunohistochemically, the epithelial cells were partially positive with a monoclonal antibody to herpes simplex virus type 1 (HSV-1). Herpes esophagitis: A cause of upper gastrointestinal bleeding in an immunocompetent patient. Both antibodies (ELISA) to herpes simplex virus type 2 on admission and at 2 wk after admission were all negative.Top of pageDiscussionAcyclovir (ACV), a nucleoside analog, is most active against herpes simplex virus (HSV). Based on controlled clinical studies, it is now recognized that ACV therapy for labial and genital HSV infections safely and effectively reduces the duration and severity in both immunocompetent and immunocompromised patients (11, 12). As a general rule, the earlier that treatment begins, the more likelihood there is of influencing the disease (13).As for treatment of herpes simplex esophagitis, ACV therapy is established in immunocompromised patients (6, 7). In the immunocompetent patients, however, esophagitis commonly occurs as an acute and self-limited illness. Even in immunocompetent patients, however, severe complications, including bleeding and esophageal perforation, have recently been reported (14, 15). Therefore, ACV as well as symptomatic therapy should also be considered for immunocompetent patients.In the literature, ACV therapy in otherwise healthy and immunocompetent adults with the esophagitis has only been reported in eight patients (2, 3, 4, 5, 6, 7).
These observations suggest that therapy in immunocompetent patients may hasten the time to the resolution of symptoms. In addition, therapy may be a prophylaxis against complications.It has been speculated that herpes simplex esophagitis in immunocompetent adults may be part of a first HSV-1 infection (1). In the present case, the serological findings were consistent with a first HSV-1 infection, based on a 4-fold rise in IgG antibodies and positive finding for IgM antibodies. Recently, it has been pointed out that the incidence of the first infection of HSV in adults has been increasing in the field of dermatology as a result of a significant decline in the acquisition of HSV-1 infection in childhood (12). Therefore, it is likely that the incidence of herpes simplex esophagitis in immunocompetent adults will also increase. Such cases frequently result in severe odynophagia, and treatment, therefore, will likely become more important.We believe that the early initiation of ACV therapy for herpes simplex esophagitis is beneficial not only in immunocompromised patients, but also in immunocompetent patients with particularly severe odynophagia. There is a need for a controlled study to determine the clinical effects of ACV on esophagitis in immunocompetent patients.



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