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Acyclovir can reduce the number of days with fever in otherwise healthy children with chickenpox, but its effect on sores and itching is not yet certain

Chickenpox (varicella) is caused by a virus. It begins with a fever, followed by a rash of red pimples which become itchy sores that form scabs. Chickenpox usually affects children from one to 14 years. In young babies, adults or people with impaired immune system, chickenpox is more severe. Treatments include lotions to relieve itchiness, paracetamol (acetaminophen) for fever and the antiviral drug acyclovir. The review of trials found that acyclovir reduces the number of days of fever from chickenpox in otherwise healthy children, usually without adverse effects. It is not clear whether it improves sores and itching.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Acyclovir for treating primary herpetic gingivostomatitis

There is some weak evidence that acyclovir can be an effective treatment in decreasing some of the symptoms caused by primary herpetic gingivostomatitis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Antiviral treatment for preventing nerve pain after shingles (postherpetic neuralgia)

We reviewed the evidence about the effect of antiviral medicines for preventing postherpetic neuralgia (PHN).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Interventions for the prevention and treatment of herpes simplex virus in patients being treated for cancer

Treatment of cancer is increasingly effective, but associated with oral complications such as mucositis, fungal infections, bacterial infections and viral infections such as the herpes simplex virus (HSV). Oral complications can impact severely on quality of life and may lead to life‐threatening systemic infection. Infection with HSV can cause pain and blistering on or around the lips and within the mouth. Orofacial lesions are most commonly caused by HSV type 1. Aciclovir and other antiviral drugs such as valaciclovir, famiciclovir and penciclovir, have been widely used to treat HSV‐related conditions. Recurrent HSV type 1 infection in patients who are immunocompromised due to treatment for cancer may be more aggressive, painful and slower to heal. These more extensive lesions often require much longer treatment and leave the patient more susceptible to developing drug‐resistant strains of HSV. This review of 17 trials found evidence that aciclovir is efficacious in the prevention and treatment of HSV infections, in terms of preventing clinical/culture positive HSV infections, reduction in healing time, duration of viral shedding and relief of pain. There is no evidence that valaciclovir is more efficacious than aciclovir, or that a high dose of valaciclovir is better than a low dose of valaciclovir. There is evidence that for prevention, placebo is more efficacious than prostaglandin E. However, in all included trials, risk of bias is unclear. No trials reported on duration of hospital stay, amount of analgesia or patient quality of life.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Pharmacotherapy for Behcet's syndrome

Behcet's syndrome is a multisystemic disorder presenting with recurrent oral and genital ulcerations as well as ocular involvement. Treatment of Behcet's syndrome is symptomatic and empirical.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Use of antiviral drugs in late pregnancy for reducing the recurrence of genital herpes at labor and birth and reducing the risk of newborn HSV infection

The incidence of herpes, a sexually transmitted disease, varies across the world. Among pregnant women with herpes, nearly 75% can expect at least one flare‐up during their pregnancy. Transmission of the virus from mother to baby typically occurs by direct contact with the virus during birth. It is often recommended that a cesarean should be offered to women with active lesions to reduce the risk of transmission to the baby. In addition, several antiviral agents are available for use both for therapy and for preventing a flare‐up. These antiviral drugs include acyclovir, penciclovir, valacyclovir, and famciclovir. The review assessed whether antiviral drugs given to pregnant women with herpes before a recurrence might be effective in reducing transmission to the baby. Seven studies were identified involving 1249 women. Giving antiviral drugs reduces viral shedding and recurrences at labor and birth. They also reduced the use of cesarean, but there is no evidence of reduction in neonatal herpes. Women should also be informed that the risk of the baby getting herpes during birth is low.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Antiviral drugs used as protective and preventive therapy reduce CMV disease and CMV‐associated deaths in solid organ transplant recipients

Cytomegalovirus (CMV; a herpes virus) is the most common type of virus detected in people who have received solid organ transplants (kidney, heart, liver, lung and pancreas). CMV disease is a major cause of illness and death during the first six to 12 months after transplantation. Two main strategies to prevent CMV disease have been adopted: protection and prevention (prophylaxis) of viral infections for all organ recipients using antiviral drugs, or 'pre‐emptive therapy' of organ recipients, who develop evidence of CMV infection during routine screening.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Antiviral treatment for Bell's palsy

We reviewed the evidence about the effect of antiviral therapy alone or in combination with any other therapy, on Bell's palsy.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Antiviral drugs for sudden hearing loss (without known cause)

Idiopathic sudden sensorineural hearing loss (ISSHL) is sudden loss of hearing where clinical assessment has failed to reveal a cause. Patients may also suffer from additional symptoms such as tinnitus (a background ringing noise), together with dizziness and a sensation of fullness in the ear. Prompt investigation is essential to identify and treat the hearing impairment. In a large proportion of patients, however, no cause can be found.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Antiviral agents for treatment of herpes simplex virus infection in neonates

The virus herpes simplex (herpes) causes a rare but devastating disease in the newborn that can range from skin and eye infection to shock, organ failure, brain infection, and death. Newborn herpes infection is an uncommon complication of active genital herpes in the mother around the time of delivery or after direct contact with a herpes blister ("fever blister", "cold sore") of an infected caregiver. We reviewed five studies conducted to assess the effects of antiviral agents (medications that reduce the spread of virus in the body) on mortality and long‐term complications of herpes disease in the newborn. Antiviral agents were shown to reduce mortality from the condition, but the reduction was not statistically significant due to the small number of infants in the study. There was insufficient trial data to guide caregivers regarding the duration of antiviral therapy or dose.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Corticosteroids for preventing postherpetic neuralgia

Postherpetic neuralgia is a painful condition that is one of the most common complications of an acute herpes zoster infection. Herpes zoster presents as a localised rash resembling localised chicken pox, often called 'shingles'. Postherpetic neuralgia may persist lifelong once it occurs and has major implications for quality of life and use of healthcare resources. Corticosteroids have a potent anti‐inflammatory action, which it has been suggested might minimise nerve damage and thereby relieve or prevent the pain experienced by people suffering from this condition. Five trials were identified from a systematic search of the literature which were of high enough quality to be included in the review. These trials involved 787 participants in total. We were able to combine the results from two trials (114 participants) and there was no significant difference between the corticosteroid and control groups in the presence of postherpetic neuralgia six months after the onset of the acute herpetic rash. Two of the three other included trials reported results at less than one month, so these participants did not fulfil the current criteria for a diagnosis of postherpetic neuralgia. The last trial reported results in a format unsuitable for meta‐analysis. There were no significant differences in serious or non‐serious adverse events between the corticosteroids and placebo groups. There was also no significant difference between the treatment groups and placebo groups in other secondary outcome analyses and subgroup analyses. It can be concluded that, based on moderate quality evidence, corticosteroids are not effective in preventing postherpetic neuralgia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Pre‐emptive treatment with antiviral agents can help to reduce the risk of cytomegalovirus disease

Cytomegalovirus (CMV) is the most common cause of viral disease in people who have received kidney, heart, liver, lung or pancreas transplants (solid organ transplants). CMV is a major cause of illness and death during the first six months after transplantation. Characteristics of CMV include fever, very low white blood cell counts (leucopenia) and very low numbers of platelets (thrombocytopenia) with or without specific organ involvement.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Lasting pain after a shingles infection

Pain that continues for a long time after a shingles rash has disappeared is called postherpetic neuralgia. It is the most common complication of shingles. It is still not clear how it can be prevented or what the best treatment is.Shingles usually causes a rash accompanied by pain in the affected area. The pain usually goes away together with the rash. This is usually the case after two to four weeks. Pain that continues for longer is referred to as “postherpetic neuralgia.” In very rare cases pain can come back after a shingles infection, even if it had already gone away and the rash had healed.The main symptom of postherpetic neuralgia is pain in the nerves (neuralgia). The skin is often overly sensitive and itchy as well. This can make it difficult or painful to wash, turn over in bed, or hold someone in your arms. The pain and itching can be very severe and might even keep you from sleeping.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 19, 2014

(Oral antiviral treatment to prevent genital herpes outbreaks in immunocompetent and nonpregnant patients)

Are oral antiviral drugs (acyclovir, famciclovir, and valacyclovir) effective compared with placebo? And is one of these three drugs superior to the others in suppressing genital herpes outbreaks in patients experiencing four or more recurrences per year? Effectiveness in this review was evaluated by determining the risk of experiencing at least one recurrence during the treatment period in each group.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Antiviral medicines, interferon, and corneal surface removal in the treatment of herpes simplex virus infection of the eye

We compared different treatments of people's eyes infected with herpes simplex virus (HSV).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Uncertainty about usefulness of antiviral drugs in Ramsay Hunt syndrome

It seems logical that antiviral drugs might help patients with a herpes virus infection of the ear producing facial weakness (a condition known as 'Ramsay Hunt syndrome'). These drugs often help similar viral infections elsewhere in the body. However, trials that might address this issue have not been done and there is therefore some uncertainty about their usefulness. Since patients can experience side‐effects when taking these drugs, the risks of these have to be balanced with the unknown prospect of benefit when considering whether to use them in Ramsay Hunt syndrome.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Corticosteroids used in addition to antiviral drugs in patients with Ramsay Hunt syndrome

Ramsay Hunt syndrome (also known as herpes zoster oticus) consists of weakness of the face due to infection with the varicella zoster virus.  Five cases arise per 100,000 of the population per year in the US.  It is more common among those over 60 and rare in children. Other symptoms may include severe ear pain and small blisters on the outer ear or in the mouth.  Prompt diagnosis and treatment (ideally within 72 hours of the onset of symptoms) are crucial to secure the best outcomes. In cases where treatment has been started within this time period, facial weakness recovers in up to 75% of patients. Standard treatment is with antiviral therapy (most commonly acyclovir). Corticosteroids are known for their anti‐inflammatory properties and are commonly used together with antivirals to reduce the inflammation in the facial nerve.  This is thought to be the cause of the facial weakness.  The aim of the review was to see if corticosteroids, used at the same time as antiviral drugs, improved outcomes in patients with Ramsay Hunt syndrome.  However the review found no trials matching the inclusion criteria, and no conclusions can be drawn about the effectiveness of using corticosteroids in this way.   It is recommended that high‐quality randomised controlled trials be undertaken to address this issue.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Interventions for the management of oral ulcers in Behçet's disease

This review has been conducted to assess the effects of different interventions, administered systemically or topically, for the prevention or treatment of oral ulcers in people with Behçet's disease. The interventions could be compared with an alternative intervention, no intervention or the administration of a placebo.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Prophylaxis with Immunoglobulin G (IgG), anti CMV vaccine or interferon do not significantly reduce CMV disease and CMV‐associated mortality in solid organ transplant recipients

Cytomegalovirus (CMV) is the most common virus causing disease and death in solid organ transplant recipients (kidney, heart, liver, lung and pancreas) during the first six months after transplantation. This review looked at the benefits and harms of IgG, anti CMV vaccines and interferon to prevent CMV disease in solid organ transplant recipients. Thirty seven studies (2185 participants) were identified. This review shows that IgG did not reduce the risk of CMV disease or all‐cause mortality compared with placebo or no treatment. The combination of IgG with antiviral medications (aciclovir or ganciclovir) were not more effective than antiviral medications alone in reducing the risk of CMV disease or all‐cause mortality. Anti CMV vaccines and interferon did not reduce the risk of CMV disease compared with placebo or no treatment. Currently there are no indications for IgG in the prevention of CMV disease in recipients of solid organ transplants.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

What treatment options are there for warts?

Warts are almost always harmless and usually go away on their own after a few weeks or months. But they can be bothersome and unattractive. They may also cause pain, especially on the feet. Different treatments are available that can help warts go away faster.Warts are caused by the human papilloma virus (HPV), of which there are more than 100 different types. Warts are most common on the hands and feet, and on your face. They may also appear in the genital and anal areas. This information does not cover treatment of genital warts.Warts are more common in children and young people. They usually appear one at a time and usually go away on their own within a few weeks or months. So many people decide not to have them treated and just wait until they disappear.Warts can be very bothersome and a real annoyance if they are on a prominent part of the body. Some people also have a lot of warts that have not cleared up. Many of them are interested in getting effective treatment.There are a number of different treatments that can improve the chances of getting rid of warts faster, but they do not always work. There is not yet a treatment that has been shown to help with warts on the bottom of the feet. Because these warts also press inwards, they are especially difficult to treat. Also, new warts may continue to develop afterwards, because a successful treatment does eliminate the possibility of viruses or infected skin cells growing back.Two common treatments for warts are salicyclic acid and cryotherapy. There have also been the most thorough studies into the effectiveness of these treatments.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 30, 2014

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