Main Article Content

Abstract

Aim & Objectives



  1. To study the prescription patterns in Herpes Zoster cases in BRIMS Tertiary Hospital. 2. To assess the efficacy, tolerability and adverse drug reactions of the drugs used in treatment of Herpes Zoster.


Materials and Methods


This was a prospective study conducted on both outpatients and inpatients of BRIMS Tertiary Hospital, Bidar, from 11-8-2014 to 12-08-2015 on patients with herpes zoster attending Department of Dermatology. A total of 90 patients with herpes zoster who presented within 72 hours of the onset of rash were enrolled in the study and randomized into three groups of 30 each of whom 30 patients assigned Valacyclovir 1000 mg TID, 30 patients were assigned Acyclovir 800 mg five times a day and Famciclovir 250 mg BD for 7 days. The treatments were given for 7 days. Patients were periodically followed up till day 29 to assess the effect of the drugs on the rate of resolution of pain, cessation of abnormal sensations, rate of rash healing, new lesion formation and occurrence of complications.


Results


The pain scores (measured by VAS) between the groups were compared and a significant reduction was observed in Valacyclovir group day 22 (P=0.013) and day 29 (P<0.0004). A significantly greater proportion of patients in Valacyclovir group did not have Zoster associated pain at day 29 (P=0.003). All the three drugs showed significant reduction in pain scores within the group between 2 consecutive visits. This trend was persistent throughout the study period. The rate of cessation of abnormal sensations, rash healing, new lesions formation and occurrence of complications was similar in three groups. Adverse events were infrequent and mild in nature. Headache, nausea, vomiting and abnormal pain were reported which did not warrant discontinuation and withdrawal from the study.


Conclusion


In the management of HerpesZoster the reduction of pain was best with Valacyclovir better with Famciclovir and least in Acyclovir. Other than resolution of pain which is faster with Valacyclovir than compared to Acyclovir and Famciclovir, there is no difference in outcome of rash healing, abnormal sensation and adverse effect with three drugs.

Keywords

Valacyclovir Acyclovir Famciclovir Herpes Zoster

Article Details

How to Cite
Savitha.A, & Kashinatha Gumma. (2021). Study of prescription pattern in the management of herpes zoster at brims hospital, bidar. International Journal of Research in Pharmacology & Pharmacotherapeutics, 8(1), 87-96. https://doi.org/10.61096/ijrpp.v8.iss1.2019.87-96

References

  1. [1]. Pharmacy communication In Hassan WE editor Hospital Pharmacy Lea and Febiger, Philadelphia, 5, 1985, 154-1594.
  2. [2]. The rational use of drugs: report of the conference of experts. Nairobi, 1985. Geneva, World Health Organization, 1987.
  3. [3]. Gnann JW, Whitley RJ, Herpes Zoster. N Engl J Med; 347(5), 2002, 340-346.
  4. [4]. Opstelten W, Eekhof J, Neven AK, Verheij T. Treatment of herpes zoster. Can Fam Physician; 54, 2008, 373-377.
  5. [5]. Tyring SK, Beutner KR, Tucker BA, Anderson WC, Crooks RJ. Antiviral therapy for herpes zoster. Randomized, controlled clinical trial of Valacyclovir and Famciclovir therapy in immunocompetent patients 50 years and older. Arch Fam Med; 34, 2000, 138- 142.
  6. [6]. Beutner KR, Friedman DJ, Forszpaniak C, Andersen PL, Wood MJ. Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults. Antimicrob Agents Chemother; 39(7), 1995, 1546-1553.
  7. [7]. Schmader K. Management of herpes zoster in elderly patients. Infect Dis Clin Pract. 4, 1995, 293–9.
  8. [8]. Beutner KR, Friedman DJ, Forszpaniak C, Andersen PL, Wood MJ. Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults. Antimicrob Agents Chemother. 39, 1995, 1546–53.
  9. [9]. Whitley RJ, Weiss H, Gnann J, Tyring S, Mertz GJ, Pappas PG, et al. Acylclovir with and without prednisone for the treatment of herpes zoster. A randomized, placebo-controlled trial. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Ann Intern Med.;125, 1996, 376–83
  10. [10]. Eaglstein WH, Katz R, Brown JA. The effects of early corticosteroid therapy on the skin eruption and pain of herpes zoster. JAMA; 211, 1970, 1681–3.
  11. [11]. Keczkes K, Basheer AM Do corticosteroids prevent post-herpetic neuralgia? Br J Dermatol.; 102, 1980, 551–5.
  12. [12]. Esmann V, Geil JP, Kroon S, Fogh H, Pererslund NA, Petersen CS, et al. Prednisolone does not prevent post-herpetic neuralgia. Lancet; 2(8551), 1987, 126–9.
  13. [13]. Dworkin RH, Gnann JW, Oaklander AL, Raja SN, Schmader KE, Whitley RJ. Diagnosis and assessment of pain associated with herpes zoster and postherpetic neuralgia. The Journal of Pain; 9, 2008, S37-S44.
  14. [14]. Nikkels AF, Piérard GE. Oral antivirals revisited in the treatment of herpes zoster: what do they accomplish? Am J Clin Dermatol; 3(9), 2002, 591-598.
  15. [15]. Tyring SK, Beutner KR, Tucker BA, Anderson WC, Crooks RJ. Antiviral therapy for herpes zoster. Randomized, controlled clinical trial of valacyclovir and famciclovir therapy in immunocompetent patients 50 years and older. Arch Fam Med 9(9), 2000, 863-9.
  16. [16]. Lin WR, Lin HH, Lee SSJ, Tsai HC, Huang CK, Wann SR, et al. Comparative study of the efficacy and safety of valaciclovir versus acyclovir in the treatment of herpes zoster. J Microbiol Immunol Infect; 34, 2001, 138-142.