PHARMACOLOGICAL OVERVIEW OF ACYCLOVIR
DOI:
https://doi.org/10.5281/zenodo.15024249Keywords:
Although it does not eradicate latent virus, acyclovir remains the standard antiviral therapy for various manifestations of HSV infections and represents a significant advancement in antiviral treatment. Outside of VZV infections, the efficacy of acyclovir against other herpesviruses has generally been limited in clinical trials.Abstract
Acyclovir (also known as aciclovir) is a nucleoside analogue with potent antiviral activity against several members of the herpesvirus family. As a widely accepted treatment for herpes simplex virus (HSV) infections, acyclovir is available in intravenous, oral, and topical forms, demonstrating substantial clinical benefit in managing genital herpes and recurrent oral herpes. Early initiation of therapy is particularly effective, especially in non-primary infections, which are generally milder than primary episodes. Long-term oral prophylaxis in patients with frequent recurrences can significantly reduce, and in many cases, fully suppress outbreaks; however, viral latency persists, and recurrence typically resumes once treatment is discontinued. Caution is advised regarding widespread prophylactic use, due to the potential development of acyclovir-resistant viral strains, particularly those with altered or absent viral thymidine kinase activity. Intravenous acyclovir is the treatment of choice for biopsy-confirmed herpes simplex encephalitis in adults and has proven successful in treating disseminated HSV during pregnancy and in neonates. While systemic acyclovir effectively limits the spread and severity of varicella-zoster virus (VZV) infection, it does not prevent postherpetic neuralgia. In immunocompromised individuals, all formulations (IV, oral, and topical) shorten the duration of HSV symptoms, and prophylactic administration suppresses reactivation during therapy. Ophthalmic use of 3% acyclovir ointment promotes rapid healing of herpetic dendritic corneal ulcers and superficial keratitis
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