The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.
Letter to the editor
Editor, – The two recent articles on antiviral drugs were excellent - 'Antiviral drugs - mechanisms of action' by S. Locarnini (Aust Prescr 1993;16:78-81)and 'Antiviral drugs - clinical applications' by A.C. Street(Aust Prescr 1993;16:81-6). However, I felt that Dr Street's judgement that topical acyclovir (5% aqueous cream - which is unavailable in Australia) for orolabial and genital herpes simplex virus (HSV) infections had no clinical efficacy was a little harsh. I agree that it seems that the benefit of topical acyclovir for orolabial and recurrent genital HSV infections in immuno competent patients is limited to a reduction in viral shedding. However, topical acyclovir may have a role in primary genital herpes in immuno competent hosts. It reduces the duration of the lesions, but has minimal efficacy in reducing new vesicle formation.1,2
In immuno compromised patients with mucocutaneous HSV disease, topical therapy also results in a significant reduction in the period of pain and healing of lesions.3,4
Topical therapy may have an effective clinical application in the management of primary genital HSV infection, and minor mucocutaneous HSV infections in immuno compromised patients.5
- Fiddian AP, Kinghorn GR, Goldmeier D, Rees E, Rodin P, Thin RN, et al. Topical acyclovir in the treatment of genital herpes: a comparison with systemic therapy. J Antimicrob Chemother 1983;12 (B Suppl):67S-77S.
- Corey L, Nahmias AJ, Guinan ME, Benedetti JK, Critchlow CW, Holmes KK. Atrial of topical acyclovir in genital herpes simplex virus infections. N Engl J Med 1982;306:1313-9.
- Whitley R, Barton N, Collins E, et al. Mucocutaneous herpes simplex virus infections in immuno compromised patients: a model for evaluation of topical antiviral agents. Am J Med 1982; 73:236-40.
- Whitley RJ, Levin M, Barton N, Hershey BJ, Davis G, Keeney RE, et al. Infections caused by herpes simplex virus in the immuno compromised host: natural history and topical acyclovir therapy. J Infect Dis 1984;150:323-9.
- Whitley RJ, Gnann JW Jr. Acyclovir: a decade later. N Engl J Med 1992;327:782-9.
- Corey L, Benedetti J, Critchlow C, Mertz G, Douglas J, Fife K, et al. Treatment of primary first episode genital herpes simplex virus infections with acyclovir: results of topical, intravenous and topical therapy. J Antimicrob Chemother1983;12 (B Suppl):79S-88S.
- Luby JP, Gnann JW Jr, Alexander WJ, Hatcher VA, Friedman-Kien AE, Klein RJ, et al. A collaborative study of patient-initiated treatment of recurrent genital herpes with topical acyclovir or placebo. J Infect Dis 1984;150:1-6.