In this updated review for Issue 4, 2005, we reran the electronic searches in June 2005 and found no new trials that met the inclusion criteria for the review. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms. Do not let your child chew, break, or crush. Acyclovir {9-[(2-hydroxyethoxy)-methyl]guanine} is an antiviral agent which has been shown to be effective in the prevention and treatment of herpes simplex virus (HSV) and varicella-zoster virus (VZV) infections ().It is also used for prophylaxis of cytomegalovirus infection following solid organ transplantation ().Acyclovir exhibits a selective inhibition of herpes virus replication and has . If your child misses a dose of acyclovir, do not double the dose, but give it as soon as you or your child remember. Protocol first published: Issue 4, 2000 The secondary objective was to examine complications of chickenpox and adverse effects associated with acyclovir, as reported in the relevant efficacy trials. In addition to the main hospital, Children's has many convenient locations in other neighborhoods throughout the greater Pittsburgh region. Talk with the doctor if your child is pregnant, becomes pregnant, or is breast-feeding a baby. Similarly, excessive drooling resolved faster (P < .05). Although acyclovir will not cure herpes, it does help relieve the pain and discomfort and helps the sores (if any) heal faster. Acyclovir was associated with a reduction in the number of days with fever (1.1 days, 95% CI 1.3 to 0.9) and in reducing the maximum number of lesions (76 lesions, 145 to 8). Centers for Disease Control and Prevention. 6 exp Acyclovir/ In summary, acyclovir therapy can slightly decrease the severity and duration of acute varicella. et al. Gum swelling and drooling resolved faster (5 vs 7 days and 4 vs 8 days, respectively), and viral shedding stopped earlier (4 vs 10 days). Finally, we wish to thank Mohammad Karkhaneh and David Jones for assistance with screening the search results. Store at room temperature. We invite you to submit them to the PRETx program by fax at 604 875-2414; they will be addressed in future Child Health Updates. An open study from the 1980s with 33 children showed that acyclovir was associated with resolution of fever after 3 days, and considerable improvement (90%) of oral lesions and pain within 6 days.7 A retrospective study from Italy8 reported that among 162 young children, symptom regression was faster in those treated for 5 to 6 days with acyclovir, compared with those who received no antiviral therapy. Children 12 years of age and above2000 milligrams (mg) every 12 hours for one day. However, it does not work in treating certain virus infections . Allow to dissolve for at least 6 hours. The disease is more severe in neonates (Gershon 1975; Meyers 1974), adults (Preblud 1981), and individuals who have impaired immune systems (Feldhoff 1981; Feldman 1975). Talk with the doctor. The purpose of this study is to test whether long term treatment with acyclovir given orally (by mouth) improves the outcome for infants with herpes simplex virus infection of the brain or spinal cord (known as the central nervous system [CNS]). Supplemental content provided by Healthwise, Incorporated. When initiated within 24 hours after rash onset, treatment with acyclovir shows a therapeutic benefit in reducing the length of time with fever and the number of maximum lesions in immunocompetent children; results are less convincing with respect to the number of days to no new lesions, the maximum number of lesions and relief of itchiness. Two recent studies12,13 have failed to confirm the effectiveness of ribavirin. The current recommended dose of oral acyclovir is 40 to 80 mg/kg a day, divided in 3 or 4 doses, for 7 days. Acyclovir appears to be effective in reducing the number of days with fever and the maximum number of lesions among otherwise healthy children with chickenpox. Carroll D, If you have questions about side effects, call your childs doctor. Aciclovir slows the growth and spread of the virus so that your child's body can fight off the infection. Be ready to tell or show what was taken, how much, and when it happened. Tell all of your childs health care providers that your child is taking this drug. Differences were resolved by consensus. KATHERINE L. MARGO, M.D., AND ALLEN F. SHAUGHNESSY, PHARM.D. Our highly-specialized educational programs shape leaders to be at the forefront of cancer care and research. For more resources, visit www.mskcc.org/pe to search our virtual library. It is used to prevent and treat herpes infections of the skin, mouth, and mucous membranes; herpes zoster (shingles); chicken pox; and genital herpes. Support the hospital by making a donation online, joining our Heroes in Healing monthly donor program, or visiting our site to learn about the other ways you can give back. The oral medication is available in 400- and 800-mg tablets and 200-mg capsules. Kelly JM, Do not store in a bathroom. Acyclovir also has been used to prevent the development of chickenpox following household exposure. All three studies received pharmaceutical sponsorship. Cet article est disponible en franais. Pain resolved faster with acyclovir (P < .05), but the authors provided no explanation for how this was measured. Talk with your childs doctor before you use other drugs or products on your childs skin. Use within 1 hour after the first signs of a cold sore. Ducoulombier H, Cousin J, Dewilde A, Lancrenon S, Renaudie M, Steru D, et al. Klassen TP, Notify your coordinator if your child experiences these effects. Do not swallow, chew, or suck the tablet. These substitutions give less conservative estimates of variance. Published Child Health Updates are available on the Canadian Family Physician website (www.cfp.ca). The three relevant trials were conducted in the United States and were published in English. Ranked #6 Nationally by U.S. News & World Report. Study quality was three (n = 2) and four (n = 1) on the Jadad scale. Thirteen studies were identified as being potentially relevant. Children up to 12 years of ageDose is based on body weight and must be determined by the doctor. In some children, treatment with acyclovir is an alternative to vaccination for the treatment and prevention of chickenpox. Low red blood cells and. Get the latest news and updates on MSKs cancer care and research breakthroughs sent straight to your inbox with our e-newsletters. The usual dose is 10 mg to 20 mg of acyclovir per kg (4.5 mg to 9.1 mg per pound) of body weight, injected slowly into a vein over at least a one-hour period and repeated every eight hours for seven to ten days. Do not start, stop, or change the dose of any drug your child takes without checking with the doctor. Use of immune globulin has been shown to reduce the incidence of hospital admissions and the duration of hospitalization for respiratory syncytial virus infections or other respiratory infections.15 It is given once per month during the respiratory syncytial virus season to children less than two years of age with bronchopulmonary dysplasia who have received or are receiving oxygen therapy. We thank Natasha Wiebe and Elaine Belseck for their involvement in earlier versions of the review. The effect of treatment on the development of complications is not known. This content is owned by the AAFP. Those involving the respiratory system included: runny nose (18 acyclovir; 23 placebo); cough (23 acyclovir; 29 placebo); ear pain/redness (five acyclovir; six placebo); sore throat (24 acyclovir; 33 placebo). There may be drug take-back programs in your area. Nasser M, Fedorowicz Z, Khoshnevisan MH, Shahiri Tabarestani M. Acyclovir for treating primary herpetic gingivostomatitis. However, many people have no side effects or only have minor side effects. Chickenpox (varicella) is caused by a virus. The .gov means its official. Rotbart HA, La traduction en franais de cet article se trouve www.cfp.ca dans la table des matires du numro de mai 2016 la page e241. The review authors believe that the question is no longer relevant to current clinical practice. The number of days to no fever was reduced by treatment with acyclovir in all three trials: 1.1 days (1.3 to 0.9). Since the adverse event data were not independent (the numbers were reported by event not by patient), risk differences could not be calculated nor any further analysis. Do not let your child suck on this product. Dr Goldman is Director of the PRETx program. The immune response following varicella is not affected by acyclovir therapy. At present, there appear to be too many unanswered questions to advocate the widespread use of acyclovir in otherwise healthy children. Goodman JL, Your child may eat and drink when using this drug. 5 or/14 Some drugs may have another patient information leaflet. The treatment of chickenpox with acyclovir may become immaterial as public health authorities worldwide move towards adopting the varicella vaccine to protect against VZV (CDC 2001; DrwalKlein 1993). Maccarini I, Ghirga P, If the drug is swallowed within the first 6 hours, have your child drink a glass of water and put in a new tablet. Whitley RJ, Hsueh C. Oral acyclovir prophylaxis of varicella after intimate contact. HHS Vulnerability Disclosure, Help and transmitted securely. Individual study results were pooled and chisquare tests were the bases of the power analyses. Inclusion in an NLM database does not imply endorsement of, or agreement with, Balfour 1990 found no advantage (0 days; 95% CI 0.6 to 0.6). To learn more, visit Healthwise.org. 7 acyclovir*.tw. Defervescence occurs more quickly on average in treated children (day 1 versus day 2). 4401 Penn Ave. Save 2.20. All Rights Reserved. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? In this update, we reran the electronic searches in September 2008 and found no new trials that met the inclusion criteria for the review. Gastrointestinal problems occur infrequently. Symptomatic relief primarily involves pain management and oral fluids to prevent dehydration until the viral infection subsides. Store in a dry place. National Library of Medicine Medians were substituted for means for all outcomes in the study by Balfour et al (Balfour 1990). This drug will not cure cold sores. An official website of the United States government. Alterations in compliance may dilute already moderate results (Brunell 1991). The Cochrane Database of Systematic Reviews. Differences regarding which studies to include were resolved by consensus reached after discussion. The magnitude of the results does not support the widespread use of acyclovir among young immunocompetent children in which chickenpox is selflimiting and results in few complications. Do not flush down a toilet or pour down a drain unless you are told to do so. The clinical importance of acyclovir treatment in otherwise healthy children remains uncertain. ChildrenUse and dose must be determined by your doctor. Its effect on the subsequent development of zoster is not known. Comparison 1 Acyclovir versus placebo, Outcome 6 CNS complications. Acyclovir doses are based on weight (especially in children and teenagers). Zimmerman ME, The most frequent complication is bacterial infection secondary to cutaneous lesions (Mouzard 1998; Preblud 1984). Tell your doctor if you have any kidney problems before taking this medication. National Library of Medicine Oral banana flavored acyclovir suspension: 300 mg/m^2/dose three times a day (TID), to be given . Some reported adverse effects to the oral administration of acyclovir include nausea, vomiting, diarrhea and vertigo (Croze 1994). This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. Two meta-analyses have confirmed the lack of benefit of ribavirin on mortality, respiratory deterioration or length of hospitalization.14 As a result of this new information, the AAP recommends that ribavirin may be considered for use in infants with severe heart or lung disease or immunosuppression, or in those who are severely ill. The chance of choking may be raised. The fixedeffect result was significant (0.8 days, 0.9 to 0.6). Tell your childs doctor or get medical help right away if your child has any of the following signs or symptoms that may be related to a very bad side effect: These are not all of the side effects that may occur. Most local pharmacies keep acyclovir as a stock drug. Jadad AR, Central nervous system side effects can range from nervousness and lightheadedness to delirium, hallucinations and seizures. There were too few studies to consider exploring statistical heterogeneity between studies (i.e., differences in reported effects), formally, or to assess for publication bias. 2006: . We also wish to thank the following referees for commenting on the first update: Marilyn Oates, Michael Nissen, N. Sreekumaran Nair and Juan Lozano. Alberta Heritage Foundation for Medical Research, Canada. Immunocompromised children, including those receiving oral corticosteroids in dosages of 2 or more mg per kg per day, should receive intravenous acyclovir to prevent or treat disseminated varicella. The effect of treatment on the Jadad scale must be determined by your doctor if you have any kidney before! As a stock drug for means for all outcomes in the United States and were published English... Throughout the greater Pittsburgh region not endorse any treatments or medications as safe, effective, or crush and milligrams... 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