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Herpes B Medication

  • Author: Sowmya Nanjappa, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
 
Updated: May 06, 2016
 

Medication Summary

Specific antiviral agents are recommended as soon as possible to attempt prevention of herpes B virus disease progression in humans or when prophylaxis is indicated. No treatment is currently approved for herpes B virus infection by the US Food and Drug Administration. Early treatment has been successful in modifying infection in some animal models, but human data, albeit anecdotal, have been mixed. The progression of complications seems to be limited in some human reports. The dosing, especially for prophylaxis, is not clearly delineated. Because of its bioavailability profile, valacyclovir seems preferable to acyclovir for oral use in either treatment or prophylaxis.

Topical antiseptic compounds or preparations are used topically on potentially contaminated or infected body surfaces or on inanimate objects. In these cases, the topical antiseptics are used to inactivate any herpes B virus remaining in the wound after irrigation.

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Antivirals

Class Summary

Nucleoside analogs are initially phosphorylated by viral thymidine kinase to eventually form a nucleoside triphosphate. These molecules inhibit HSV polymerase with 30-50 times the potency of human alpha-DNA polymerase. Herpes B virus thymidine kinase has only recently been characterized. Initial in vitro study has suggested that, under experimental conditions, B virus thymidine kinase is less susceptible to several commonly used antiherpes drugs, including acyclovir and ganciclovir. This may lead to further research aimed at developing more effective alternatives than the currently accepted drugs for this infection.[7]

Acyclovir (Zovirax)

 

Synthetic purine nucleoside analogue with activity against a number of herpesviruses, including herpes B. Primarily available in preparations for PO and IV use. Highly selective for virus-infected cells because of high affinity for viral thymidine-kinase enzyme. This effect serves to concentrate acyclovir monophosphate into virus-infected cells. The monophosphate is then metabolized into triphosphate active form by cellular kinases.

Valacyclovir (Valtrex)

 

Hydrochloride salt of the L-valyl ester of acyclovir. Rapidly converted into acyclovir after prompt absorption from the gut via first-pass intestinal or hepatic metabolism. An alternative to acyclovir for prophylaxis (or possibly treatment).

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Topical antiseptics

Class Summary

These agents are to be used for decontamination of affected areas. Scrubbing should persist for at least 15 min.

Povidone-iodine (Betadine)

 

Broad-spectrum germicidal agent used topically on skin or mucous membranes. Used as a surgical scrub or topical cleanser. Elemental iodine is the active form.

Chlorhexidine oral (Hibiclens, Peridex, PerioChip)

 

Effective, safe, and reliable topical wash or PO mouthwash antiseptic. A polybiguanide with bactericidal activity; usually is supplied as a gluconate salt. At physiologic pH, the salt dissociates to a cation that binds to bacterial cell walls. Commercially available central venous catheters impregnated with chlorhexidine and silver sulfadiazine are available.

Dakin solution

 

Originally described by Dakin in 1915. Made from sodium carbonate, salt, bleaching powder, and boric acid. Today, commonly referred to 0.5% sodium hypochlorite (a 1:10 dilution of household bleach). Solution deteriorates with time and should be made fresh. Further dilutions also can be made. Some physicians use it as part of pressure ulcer management. Because of potential injury, other topical antiseptics usually are used.

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Contributor Information and Disclosures
Author

Sowmya Nanjappa, MD Assistant Member, Department of Internal Medicine, Moffitt Cancer Center; Assistant Professor of Medicine, Department of Internal Medicine and Department of Oncologic Sciences (Joint Appointment), University of South Florida Morsani College of Medicine

Sowmya Nanjappa, MD is a member of the following medical societies: American Association of Physicians of Indian Origin, American College of Physicians, American Medical Association, Infectious Diseases Society of America, Society of Hospital Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Charles V Sanders, MD Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center

Charles V Sanders, MD is a member of the following medical societies: American College of Physicians, Alliance for the Prudent Use of Antibiotics, The Foundation for AIDS Research, Southern Society for Clinical Investigation, Southwestern Association of Clinical Microbiology, Association of Professors of Medicine, Association for Professionals in Infection Control and Epidemiology, American Clinical and Climatological Association, Infectious Disease Society for Obstetrics and Gynecology, Orleans Parish Medical Society, Southeastern Clinical Club, American Association for the Advancement of Science, Alpha Omega Alpha, American Association of University Professors, American Association for Physician Leadership, American Federation for Medical Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association of American Medical Colleges, Association of American Physicians, Infectious Diseases Society of America, Louisiana State Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southern Medical Association

Disclosure: Received royalty from Baxter International for other.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Program Director of Infectious Disease Fellowship, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Larry I Lutwick, MD Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Thomas J Marrie, MD Dean of Faculty of Medicine, Dalhousie University Faculty of Medicine, Canada

Thomas J Marrie, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, Association of Medical Microbiology and Infectious Disease Canada, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Brian Hogan, MD, MPH MPH&TM, Fellow in Infectious Diseases, Brooke Army Medical Center, San Antonio Uniformed Services Health Education Consortium

Disclosure: Nothing to disclose.

Acknowledgements

Robert O Deaner, PhD Assistant Professor, Department of Psychology, Grand Valley State University

Disclosure: Nothing to disclose.

Jason F Okulicz, MD Assistant Professor of Medicine, Uniformed Services University of the Health Sciences; Staff, Infectious Disease Service, Brooke Army Medical Center

Jason F Okulicz, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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This is a photo of long-tailed macaques socializing in the wild. The long-tailed macaque, Macaca fascicularis, is a major reservoir for the herpes B virus. (Photo courtesy of Carel van Schaik)
 
 
 
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