Medications Used to Treat Herpesvirus Infections

Active against (in order of potency) HSV type 1 (HSV-1), HSV-2, VZV, and EBV

Minimal activity against CMV

Oral or IV: IV indicated when a higher serum drug level is required, as for herpes simplex encephalitis

Oral: Infrequent

IV:

In vitro inhibition of a broad spectrum of viruses, including HSV-1, HSV-2, VZV, CMV, EBV, KSHV, adenovirus, HPV, poxviruses, and human polyomavirus (JC and BK viruses)

IV: Generally used for CMV, but use limited by renal toxicity

Intravitreal injection: For CMV retinitis

Significant renal toxicity (Fanconi-type syndrome with proteinuria, glucosuria, and bicarbonate wasting)

Oral:genital herpes and herpes zoster

Infrequent

IV or intravitreal injection:CMV retinitis

Typically drug of choice for CMV

Used in HIV patients with CMV retinitis

IV form: Most common

Intravitreal injection: For CMV retinitis

Oral: Only 6 to 9% bioavailable; requires 12 capsules/day for a standard dose (1 g tid), limiting its usefulness

Primarily, bone marrow suppression, particularly neutropenia, which sometimes requires treatment*

Idoxuridine (no longer available in the United States)

Active against HSV-1, HSV-2, VZV, vaccinia, and CMV

Topical: Because of its high systemic toxicity, limited to topical ophthalmic treatment of herpes simplex keratoconjunctivitis

Irritation, pain, photophobia, pruritus, inflammation or edema of the eyelids

Rarely, allergic reactions

Active against CMV

IV or oral: CMV prophylaxis in bone marrow and renal transplant patients

Nausea, vomiting, diarrhea, peripheral edema, cough, headache, fatigue, abdominal pain

Active against CMV

Oral: Used to treat refractory CMV disease

Dysgeusia, diarrhea, nausea, vomiting

Active against HSV-1, HSV-2, VZV, and EBV

Topical (cream): Used to treat recurrent herpes labialis in adults

Erythema

Active against HSV-1 and HSV-2

Topical: Ophthalmic treatment of primary keratoconjunctivitis and recurrent keratitis or ulceration caused by HSV-1 and HSV-2

(Systemic use precluded by bone marrow suppression)

Ocular stinging, palpebral edema

Less commonly, punctate keratitis, allergic reactions

Oral:

TTP/HUS in some patients with advanced HIV

Oral:

Vidarabine (adenine arabinoside, ara-A)

HSV infections

IV form not used anymore because of neurotoxicity

Ophthalmic preparations: Effective for acute keratoconjunctivitis and recurrent superficial keratitis caused by HSV-1 and HSV-2

Superficial punctate keratitis with tearing, irritation, pain, and photophobia