Antiviral agents for treatment of herpes simplex virus infection in neonates
By www.ncbi.nlm.nih.gov
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.
Background: Herpes simplex virus (HSV) is a rare but serious neonatal pathogen. Prior to the availability of antiviral drugs the mortality associated with all but localised neonatal infection was high, with 85% of infants with disseminated HSV infection and 50% of infants with encephalitis dying by one year of age. The morbidity in the survivors of multiorgan infection was also high, with up to 50% experiencing long-term neurological sequelae.
Objectives: To determine the effect of antiviral agents in the treatment of neonatal HSV infections on mortality, progression of disease and neurodevelopmental sequelae at approximately one year. The secondary objective was to assess the effect of antiviral agents on major complications associated with the use of these agents including nephrotoxicity and bone marrow suppression.
Search methods: Trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2008), MEDLINE (1996 - Nov 2008), EMBASE (1982 - Nov 2008) and reference lists of published trials.
Selection criteria: Randomised and quasi-randomised controlled trials of antiviral therapy in infants less than one month of age with virologically proven HSV infection were included.
Data collection and analysis: Data were extracted and the analyses performed independently by two review authors. Studies were analysed for methodological quality using the criteria of the Cochrane Neonatal Review Group. All data were analysed using RevMan 5.1. When possible, meta-analysis was performed to calculate typical relative risk, typical risk difference, along with their 95% confidence intervals (CI).
Main results: Two eligible studies of a total of 273 infants were included. Both studies were randomized controlled trials. One study treated 63 infants with vidarabine or placebo (Whitley 1980) and the other study treated 210 infants with aciclovir or vidarabine (Whitley 1991).
In the study comparing vidarabine with placebo (Whitley 1980), infants with all forms of neonatal HSV disease were included [disseminated disease, central nervous system (CNS) disease alone, and skin, eye and mouth (SEM) disease].There was no significant reduction in the risk of mortality when analyzed as an entire group; however, mortality was significantly reduced when data from infants with CNS disease or disseminated disease were combined. There was no difference in the rate of neurological abnormalities in survivors at one year when analyzed as an entire group or by disease category.
There was no difference between aciclovir and vidarabine (Whitley 1991) in preventing mortality from neonatal HSV disease, in preventing disease progression, in reducing the incidence of neurological abnormality at one year, or in the incidence of drug-induced renal or bone marrow toxicity. In infants with SEM disease, there was no significant difference in neurological outcome with aciclovir compared vidarabine treatment. Both drugs were well tolerated in the newborn period.
Authors' conclusions: There is insufficient trial evidence to evaluate the effects of antiviral agents with controls or with each other. The rarity of the condition makes effectively powered clinical trials difficult to perform. The efficacy of newer antiviral agents with better bioavailability (e.g. valaciclovir, valganciclovir) for the treatment of neonatal disease needs to be evaluated in randomised trials. The efficacy of oral formulations need to be evaluated as they may be useful for infants with skin, eye or mouth HSV disease or in the treatment of infants with recurrences after the neonatal period.
Source: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0012614/
Wednesday, May 27, 2026
Cellulitis: Skin Infection Causes and Care
Cellulitis is a common bacterial infection of the skin and the soft tissue beneath it. It can occur anywhere on the body but most frequently affects the lower legs. Unlike some skin infections that remain on the surface, cellulitis penetrates into deeper layers of the skin and can spread rapidly if not treated promptly. Understanding what causes cellulitis and how to treat it effectively is important for preventing serious complications. Cellulitis typically develops when bacteria enter the skin through a break in the surface. This can happen through cuts, scrapes, insect bites, surgical wounds, cracked skin from athlete's foot, or skin conditions like eczema. The most common bacteria responsible for cellulitis are Streptococcus pyogenes and Staphylococcus aureus. Symptoms include redness that spreads outward from the initial site, warmth, swelling, pain or tenderness, and sometimes fever and chills when the infection is more significant. Treatment of cellulitis typically requires oral antibiotics for mild to moderate cases and intravenous antibiotics for severe infections or those that fail to improve with oral therapy. The choice of antibiotic depends on the suspected organism. Amoxicillin covers streptococcal cellulitis effectively. However, when MRSA is suspected due to risk factors or clinical presentation, different antibiotics such as trimethoprim-sulfamethoxazole or clindamycin are used. Patients can consult providers and obtain appropriate prescriptions through services like https://www.amoxilcompharm.com/. Patients with cellulitis should monitor the borders of redness carefully. Drawing a line around the edge of the redness with a marker helps track whether the infection is spreading or responding to treatment. If the redness expands beyond the marked border within 24 to 48 hours of starting antibiotics, the patient should seek medical attention. Other warning signs requiring prompt care include high fever, rapidly spreading redness, or the development of blisters or skin breakdown. People with diabetes, poor circulation, lymphedema, or compromised immune systems are at higher risk for cellulitis and its complications. These individuals should treat any skin wounds promptly and seek early medical evaluation for any developing skin infection. For educational content on cellulitis, skin infections, and appropriate antibiotic treatment, visit https://amoxicillina.online/ for accessible patient health information.
Subscribe to:
Post Comments (Atom)
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.