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Fast Shingles Cure

Fast Shingles Cure

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Acyclovir 10-12 mg (x< ky iV i iilined m» I ICuilnixh illusion ol trji-ctose aeyöuv» (2 it<g |xv kg per l«| wjccujViI in 1 pi aiIIi mm hOC0h MB(SOOrngpor ^ fiunwtiape vaijocfc iNtJU.3X731!. .1997) Mortakty £gh¡43%! inL ADSpts/M JWOs 6 200?/

«je focommendations (or Prevention: Snx.e - 5% til cases öl v.wciHla tiulV-50% i* vonceiia-fcirited cfcxiths occui ri .Kkiits -20 yrs ol age. the ■ COC reconirntxKls a morn aggressive nppruoch m ttxs oqo group 1st. varicella-zoator immune globulin iVZGf (125 umls pa 10 kg (22 lbs) body m^a M lo a max >X 625 urits. mnmn doso is 125 i*»ts) is tocixnmcndod for posl-expostxe prophylaxis si strscctittifcr porsore. .il great*« risk, lor ccnphcaticins («nmunucompfomised such ns HV. mofcgnanciec. prognancy. and steroid rxj as sopn as possible after exposuro I 96 las) It win-'-il.uVjvolofis imti.iti'i» ij.i *ly (c24 lirr. of tasti) witti acyclovir au t»low Some would rx presumptively with .uiy* .-vn n t ■ ¡'insk [>.'. 2nd, susceptible adults «houklhe vaccinated Chrck .inlitxxty m odulti wtf« negative or uncertain hx ot varicella (10 30%wli be Abrxxt | and vacrinaie it-. . •■ .if Alii • ■) 3rd. usceptiitocfuklren shouldriy-aeva . ui.it>,n Recommendedt •in-et/tieture.ige 12-18n :«,t X .it .»-,• »j.

Herpos zoster (shingles) •

Prevention—Post-exposure prophylsxls

Vancotta was tne fonrlnu cause iV vneemo preventable deaths n cftidieri m tfie 'J S (V/.fAW -1/ 361. I'joej Nim irafkorty tMjuced wilti v.nxino tmt slrl deaths m unvdcdnatod (MMWR 54 272, 2005)

Normal host

Eltoclivu ix mool evident mpls -50 yts (For f" ol paeff*narpofiT neuralgia, sen CID 36 «77. Mai 25-lokl I «I /ostet aller •riirmnimtiah (MMWfl 48A-6. 1999)

New v.Kcno i tmrpes /osier & posl Imrpotc neuralgia (MEJM 352 2271. AW)

(NOTE: Trials showing benolit ot rx: only In pts treated within 3 days ol onsot ol rash] Valacyclovlr 000 rii(j | - luttim. -. 7 ifciy. I.irl|ust doso lateral laiixe) OR

Famciclovir rw mi |«,q24tior 500 mq ¡mint 250my 3 times t)a iiiy tunes 7 days ouuut efficacy IJ Clni Virol

. ..j- . . J. --II.' t! a •.»,... ■ • •,:.. • •• OR

Acyclovir 800 mg po 5 tarie* |«< i lay times 7 10 days Prednisone 30 run 1» 1*1 itiy. 1 7. 15 n»;t l«ddays 8 • 4 and 7 5 my 1*1 da,'. 15-21 also recommendod by some aiitxxrtios in pts >50 yi* ol age tKEJU 335 32. 1996)] andespeo.i0yuAx«i (4 has largo rxsriU« ol lesions I >21) or* tor severe pan at prosurtatiori I JO 179 9. 1999/

Valacyclovit 1 poul-herpeiic neuralgia more tnpidly than acyckwit In pis -SOytsdloge nn^l'.in ilui.itioo ol /oslot-associiilixl pain was 38 days with vnincyckwr and 51 dayu on acyclovir (AAC 39 1546. 19951

Todcty ol both drugs, pn nfat. ffcfn/*n.Med 9 863, XOOj

Tirno lo IhwIiiki moro "liI'll rcoduaid posl-tKiixrtc mxx itgin (PHfili v. placebo in pis >50 yts ul age rluralxxi nl PHN witlilomocimM 63 days, placolio 163 days ramctdovii simitai lo acyclovir in (eduction i.-l acuta potn aiid.PHN (J Mao tamun&.M 37 75.2004)

A meta-ariaiyss 4 (l,i,:i<x>-cixitic*xl iiiiils t69f plsi dortx»istiali.xj thai acyckMt occHoraiod a)iixrr> 2-lc*l |«n lesokmori by all nKxisuns employed ,md teduced fiosl tiuifx''tK rxnxalgui al 3 & 6 mos ICID 22 341. 19961. mod Uno lo tesnMiori ol pom 41 days vs 101 days m those 50 yts Piertxsono oddixl to ucydar* improved quaMy ol Me mcasuemvnts (i acukr pan. sloop, and return tn »mill actMty) (ArVM 125 376 1996) n posi-l»jiotic noisaloa conlinSodliialsdanonsliatedetlocI rrermss ot ganapxrtff. the hdocrsno ptilch 15%) & opad orusgesx: in comroAng pan I Drugs 64 937.2V04.

trve but rrxtr^t/xne is t*

Immunocompromised host

J Ctn Viol 29 248. 2004/ Norttfityteio & atMripMne aro ixfjaiy olloctive but iv«ti<,:/irii> it hotter Metaled

Severe -1 dormalame tnyornm.il rxxvx» or ctsseminat«!

Acyclovir 600 mg po 5 times per day trnos 7 days (Options: Famciclovir *;o my j» t)24h a 500 mg btd or 250 mg 3 lanes I. :•,"'" I ,. OR valacyclovit . j ■ it: ■ : .. " A.«« •■ r

Acyclovir 10 i2mgpakglV(inh«ioiiovoi t in) q8h limes 7 tidoys In rJ.lm pis I to 7 5 my fier kg II nephrotorx-ity and pt rfiurp-.iui > lo 5ii'i11».-I r£i.

14 progression, switch lo IV

A common manilesialiuri ol ittimuno incontililutiari loliiiwiiig HAAP1 »i MV inlrxlixl children IJ AH Cliri htntHtti 113 742 2004)

Rx must be boniBi wilhn 72 hi'. AcyckM-fausfam VZV occus xi rtV • pts previously Heated with acyclovir Foscamet ,(40 im I pix Vy IV q81i lex 14 26 d-irs) successful m 4>5 its txit 2 te.i) win 7aixl 14 rlays (AnIU 115 19. 1991)

Influenza (A A B)

Suspect or provon acuto disease

Rapid diagnostic tests available Antiviral rx cos!-ellectivo witlxxit vital lusting in trémie pi with typM-.nl symfitxns dix»« intlmm/a seasixi Pathogamc avian »itlixxiru (H5N11 m puiliy (m»n'y ducken« & ducks) xi East & Suulhoasl Asm As ot Aug 2005 112 luman caw. tirfxxled Willi 57 drhitlm since Jiui 2004 ÍM- www ede wrv/ffii'a.xin) Hixnan tutiuman transmission roported IH{JM 352 331 2005) nxxu tkrvi' had ifcitid rorSrict iMtti ixxAry iUEJM 350 1179.2004; Hjnon isolates teviJant to aman^H¿K^4riari1iKl«ie Osott.mir.v tx tccotn-u.nd"il .1 IVI.111 H5N1 sus|<x t.xl il.",',VT> 53 97 20041 1 d«J' & dixii lien oI owflamrvir txicesiuvy tor nuii^nurn effect m mouse modo! (J<0 192 665 2005. HXun- 435 4f!>. 20051 Considet Du m leturuig lra«*.ts liom Asia Alica. L.iUi America !. c-s, lixti (CIO 40 1282 2WÍ)

For Influenza A & B: also avian (H5N1) Osoltamlvlr 75 mg |jo l»d timur. 5 days (also approved 'or tx ol clxkHnti age 1 12 yts. ta» 2 mg per kg i» lo a low ■I 75 mg &d txnes 5 days) or Zanamhrir 2 atialalious (2 unes 5 mg) txd times 5 days

For influenza A only: Rimantadine . amantadine Ago l -9 yts. 5 ma pet kg put day lo max ot75mg(iotiii.1.

10-65 yts 100 mg po txd

>65yis 100mgpoq24li Mist lor 4 renal luncuon) lot 3-5 days or 1-2 days after tho disappearance of symptoms.

i t'. Willi COI-D m asthm.i potontlol risk of bronchospasm with zanamivir Armirit.iilint & rlmantiidiiH' >x|iuil,y ell'. Ire-bul nmuritarine 1 side oHoetS (Cortxiine Oatabaso Sys Km CD 001169 2004) mi dualxxi ol symptoms tiy nppnn 50% |l 2 rtiys) il given wittmi 30-36 tus aftix orit^-t ol syiiijitornii Borietil liitluonced tiy duialiori ul sx bufóte ix. tnituilKHi of usotlamivii ■willxn 1" 12 Ins utter lev« onset 1 lolal medum dimss dunlion by74 6t«s(JAC5f 123. 2003) i nek. ol pneunona & hospMi rtfoon (Cißi Mod Res Opn 21 761. 2005) Disturbing report I osoltamiva-tesslaril mus dofudod allot 4 days ot ix (Ln 364 733 i 759. 20041 In another study ol 298 rx cases ol «Us & cfxtrfron. no osoaamrv« -restslanl mitm kxnt (JtD 189 44(1 20«) T cnnCMtl iitxxlt IX/st-Jllkxxi/.l corn|X.:.iV»n rc*xlr.j community-ac»tK»od MRSA [«erxoorxa (CIO 40 f693 2005)

■ S«i(xigí»2fcr,i.Víi>,»i.'xvis HOtE AMcrjr-nje .'mxxnnxxxwxx'n ore lor (itn\n.\ or/xvwrse nxfcfitixii andnssome tyornvit rrr*V Xrrcvm Costs ttorii 2006 Dt"iTc«>csRfDBrxx Economics Price is irrw.n>e wmJesalri (»ice (AWPl

_VIRUS/DISEASE

Influenza (A ft B) Iccmin^i)

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