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/
Tuesday, May 5, 2026
Using Requip For Neuropathy: What Patients Should Know
Dealing with neuropathy can take a real toll on daily life, affecting sleep, work performance, and overall well-being. While many people try to manage symptoms with lifestyle adjustments alone, medication often plays a central role in achieving meaningful relief, particularly when symptoms are moderate to severe or recurring. Allergy treatment has advanced considerably over the past several decades. Early antihistamines were effective but caused significant drowsiness. Modern second-generation antihistamines provide comparable or superior symptom control without the sedating side effects that limited their predecessors. Other treatment modalities include nasal corticosteroid sprays, which reduce airway inflammation, and allergen immunotherapy, which gradually desensitizes the immune system through controlled exposure to specific allergens over time. Healthcare professionals frequently discuss Requip as a potential treatment for patients presenting with neuropathy. The data supporting requip for neuropathy provides a useful resource for patients who want a thorough understanding of how this medication has been studied and what clinical experience suggests about its effectiveness. One of the practical considerations with Requip is timing. Some patients find that taking the medication at a consistent time each day helps maintain stable effects. Food interactions, if any, should be noted since they can affect how well the active ingredient ropinirole is absorbed. Patients are encouraged to review the full prescribing information or consult a pharmacist for personalized guidance. Treatment of neuropathy does not always follow a one-size-fits-all approach. The parkinsons disease section on parkinsons disease covers the range of treatments that might complement or serve as alternatives to Requip, helping patients and providers find the combination most suited to individual needs.
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