Click on "Huanghuai nurse" above to follow.
guide language
The treatment scheme of herpes zoster can be roughly divided into traditional Chinese medicine therapy and western medicine therapy. Today, we will learn the western medicine therapy recommended by the guide.
Therapeutic goal of herpes zoster
Relieve acute pain; Shorten the duration of skin lesions; Prevent the spread of skin lesions; Prevent or reduce complications.
First, antiviral drugs
Commonly used drugs in clinical treatment of herpes zoster can effectively shorten the course of disease, accelerate the healing of rash, reduce the formation of new rash and reduce the spread of virus to internal organs. It should be used within 72 hours after the eruption, so as to quickly reach and maintain the effective concentration and obtain the best therapeutic effect. At present, the approved systemic antiviral drugs include acyclovir, valaciclovir, famciclovir, bromovudine and foscarnet sodium.
acyclovir
Function characteristics:
Acyclovir triphosphate is produced by phosphorylation of viral thymidine kinase in infected cells, which can inhibit viral DNA polymerase and stop the extension of viral DNA chain.
Usage:
(1) Oral administration: 400-800 mg/time, 5 times/day, for 7 days;
(2) Intravenous drip: 5 ~ 10 mg/kg for patients with immune impairment or serious nervous system diseases, once every 8 hours, with a course of 7 days.
Precautions:
Patients should drink plenty of water during the administration of acyclovir to prevent acyclovir from precipitating in renal tubules and damaging renal function.
Valaciclovir
Function characteristics:
The prodrug of acyclovir is quickly absorbed by oral administration and quickly converted into acyclovir in gastrointestinal tract and liver, and its bioavailability is 3~5 times that of acyclovir.
Usage:
Oral administration: 300 ~ 1000 mg/time, 3 times/day, for 7 days.
Fanciclovir
Function characteristics:
The prodrug of penciclovir is rapidly converted into penciclovir after oral administration, and maintains a long half-life in cells. The mechanism of action is the same as that of acyclovir, the bioavailability is higher than that of acyclovir, and the frequency and dosage of administration are lower than that of acyclovir.
Usage:
Oral administration: 250 ~ 500mg/time, 3 times/day, for 7 days.
brivudine tablets
Function characteristics:
The antiviral effect is highly selective, and the process of inhibiting virus replication is only carried out in virus-infected cells.
Usage:
Oral administration: 125mg／/day, l times/day, for 7 days.
Sodium foscarnet
Function characteristics:
Blocking the phosphate binding site of viral DNA polymerase in a non-competitive way, thus showing antiviral activity.
Usage:
Intravenous drip: 40 mg/kg each time, once every 8 hours.
Note meaning
Patients with renal insufficiency should reduce the dosage accordingly;
If renal function continues to decline, acyclovir should be stopped immediately and famciclovir or other antiviral drugs should be used to continue treatment;
For patients suspected of renal insufficiency, creatinine level should be detected before initial administration (creatinine level is not required for bromovudine).
Second, analgesics
Mild to moderate pain:Acetaminophen and tramadol can be selected;
Moderate and severe pain:
1. Opioid drugs, such as morphine or oxycodone;
2. Drugs for the treatment of neuropathic pain, such as calcium channel regulator gabapentin and pregabalin, in addition to amitriptyline and 5% lidocaine patch. Severe acute pain during herpes zoster is a risk factor for post-herpetic neuralgia (PHN). Combined with calcium channel regulator can not only effectively relieve pain, but also reduce the occurrence of PHN. Studies have shown that early use of pregabalin can significantly reduce the pain score of herpes zoster, especially within 7 days of herpes occurrence, which can significantly reduce the incidence of PHN. The pain of elderly patients with herpes zoster is more common and severe, which seriously affects all aspects of life, such as anxiety, disorder and inability to work or live normally. Studies have shown that pregabalin combined with oxycodone can not only further reduce the incidence of PHN, but also improve the daily activities and sleep of patients and improve their quality of life.
Third, glucocorticoid
At present, there is still controversy about whether to use glucocorticoid to treat herpes zoster.
It is generally believed that systematic application of glucocorticoid in the early stage of acute onset of herpes zoster and gradual decrease can inhibit the inflammatory process, shorten the duration of acute pain and the healing time of skin lesions, but it is ineffective for the pain with PHN.
Recommended dose:The initial dosage of prednisone is 30~40 mg／/day, which is taken orally and gradually reduced, and the course of treatment is 1~2 weeks.
Fourth, neurotrophic drugs
It is also helpful to relieve neuroinflammation and neuralgia. Commonly used drugs include mecobalamin, vitamin B1 and vitamin B12, etc., which are taken orally or injected intramuscularly.
Five, topical drugs
Mainly dry and anti-inflammatory.
Blister fluid is not broken:Calamine lotion, acyclovir cream or penciclovir cream can be used externally.
After herpes is broken:
3% boric acid solution wet compress;
1: 5000 furacilin solution wet compress;
0.5% neomycin ointment for external use;
2% mupirocin ointment.
Ophthalmic herpes:3% Acyclovir Eye Ointment and Iodine Eye Drops for External Use.
References: [1] Herpes Zoster Expert Consensus Working Group. Herpes Zoster Expert Consensus in China [J]. Chinese Journal of Dermatology .2018,51 (6): 403-406.
Laiyuan/Yunque