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/
Thursday, July 2, 2026
Navigating Learn more here Safely and Effectively
Navigating dosage, timing, and side effects is one of the most common challenges patients face. Mood changes, including irritability or anxiety, are worth mentioning to a healthcare provider. Insurance coverage and pricing can vary widely, so comparing options is often worthwhile. Nutrition plays a supporting role in recovery, particularly for conditions involving inflammation. Online pharmacies can offer convenience, but verifying legitimacy is an essential step. Bone health can be affected by prolonged use, making calcium and vitamin D intake more important. Weight fluctuation is common and typically stabilizes once the medication course ends. Those looking for more detail can review this learn more here for practical guidance. Pharmacists are a valuable resource for questions about timing, storage, and interactions. Hydration and a balanced diet can support the body during a course of treatment. Children are typically prescribed weight-based dosing under close medical supervision. Inflammation is the body's natural response to injury or infection, but when it becomes chronic it can cause real harm. Support groups and patient communities can offer helpful firsthand experiences. Every prescription should be taken exactly as directed to reduce the risk of complications. Storing medication in a cool, dry place helps preserve its effectiveness. Regular checkups allow a physician to adjust dosage based on how the body responds. Combining certain drugs without medical guidance can increase the risk of unwanted interactions. Seasonal allergies can flare unpredictably, and short steroid courses sometimes provide fast relief. Generic versions of many medications offer the same effectiveness at a lower cost. Skin changes, including thinning or bruising more easily, can appear with extended use. Older adults may be more sensitive to certain side effects and often start on lower doses. A dedicated resource on where to buy prednisone can help clarify what to expect. Blood pressure can rise modestly during treatment, so routine monitoring is a sensible precaution. Clear communication with a care team remains the most reliable way to stay on track. Physical therapy or gentle exercise can support recovery alongside medication. In the end, a well-informed patient is best equipped to manage their own care confidently.
Subscribe to:
Posts (Atom)