Herpes B Medication

  • Author: Brian Hogan, MD, MPH&TM; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Aug 12, 2011
 

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.[4]

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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.

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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.

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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.

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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

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

Disclosure: Nothing to disclose.

Coauthor(s)

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.

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 and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

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, Canadian Infectious Disease Society, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

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

Disclosure: Baxter International and Johnson & Johnson Royalty Other

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contribution of former coauthor Robert O Deaner, PhD, to the development and writing of this article.

References

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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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