Virus inhibition assay for measurement of acyclovir levels in human plasma and urine

A colorimetric assay for the measurement of the sensitivity of herpes simplex viruses to antiviral agents

A quantitative colorimetric method for measuring the inhibition of viral cytopathic effects has been adapted to the assay of antiviral compounds. Drug-treated, virus-infected cultures in microtiter plates were stained with the vital dye neutral red and the amount of dye incorporated was determined in a multichannel spectrophotometer. The technique required smaller volumes of reagents, was more easily automated than the standard plaque reduction assay and had good reproducibility. Standard conditions of 30 infectious units of challenge virus and 72-h incubation were judged to be optimal. Median inhibitory concentrations (ID50) for a number of compounds were approximately tenfold higher in the dye-uptake assay compared with the plaque reduction assay, possibly related to the higher multiplicity of infection required to give the desired level of cytopathic effect in the microtiter method.

Acyclovir. A review of its pharmacodynamic properties and therapeutic efficacy

Acyclovir (aciclovir) is a nucleoside analogue antiviral drug related to cytarabine, idoxuridine, trifluridine and vidarabine. In common with these earlier antivirals, acyclovir is active against some members of the herpesvirus group of DNA viruses. The efficacy of topical acyclovir has been convincingly demonstrated in ocular herpetic keratitis, and in initial and primary initial genital herpes infection, but little or no clinical benefit was seen when non-primary initial genital infections were assessed separately. Acyclovir ointment demonstrated little benefit in recurrent genital herpes but topical acyclovir cream decreased the course of the infection by 1 to 2 days. Orally and intravenously administered acyclovir were beneficial in initial genital herpes infections, and oral therapy shortened the duration of recurrent infections by 1 to 2 days but did not ameliorate pain. In non-immunocompromised patients with recurrent herpes simplex labialis, generally little clinical benefit was seen with the use of topical acyclovir ointment even when therapy was initiated during the prodromal phase, while topical acyclovir cream effected small but significant improvements in the clinical but not the symptomological course of the disease. However, in immunocompromised patients, both intravenous and topical acyclovir shortened the clinical course of herpes simplex virus infections occurring mainly on the lips, oral mucosa and face, and prophylaxis with either oral or intravenous acyclovir suppressed the appearance of recurrent lesions from latent virus for the period of drug administration, but acyclovir did not eradicate latent herpesviruses. In non-immunocompromised patients, intravenous acyclovir was shown to decrease the acute pain of zoster, especially in the elderly, but postherpetic neuralgia was not ameliorated. When immunocompromised patients were studied, intravenous acyclovir inhibited the progression of zoster infections and shortened the healing time and duration of viral shedding in patients with cutaneous disseminated zoster. However, acute and post-herpetic pain were not significantly affected. Well designed controlled studies are underway to establish the efficacy of acyclovir in herpes simplex encephalitis and cytomegalovirus infections in immunocompromised patients, infections due to Epstein-Barr virus, and neonatal herpesvirus infections. Despite some aspects of the drug's use which require further clarification, acyclovir will make a major impact on the treatment of herpesviral infections. Barring unexpected findings with wider clinical use, it will become the agent of choice in several conditions.

Treatment of first episodes of genital herpes simplex virus infection with oral acyclovir. A randomized double-blind controlled trial in normal subjects

We performed a double-blind placebo-controlled trial of oral acyclovir in the treatment of first episodes of genital herpes simplex virus infections in 48 young adults (31 women and 17 men). Subjects were randomized to receive either placebo or acyclovir (200 mg per dose) five times daily for 10 days; they were examined on at least eight visits until healed and at monthly visits thereafter. Acyclovir treatment, as compared with placebo, significantly reduced virus shedding, new lesion formation after 48 hours, and the duration of genital lesions in both men and women. The total duration and severity of clinical symptoms (such as pain, adenopathy, dysuria, and malaise) were significantly reduced by acyclovir in both men and women by the third and fourth day, respectively (P less than or equal to 0.025), as compared with placebo. No toxicity was observed. Recurrence rates have so far been similar in placebo and acyclovir recipients. Oral acyclovir treatment of first-episode genital herpes simplex virus infections is clinically effective, but it does not seem to prevent virus latency or associated recurrent disease.

Acyclovir clinical pharmacology. An overview

The current status of pharmacokinetic and toxicologic information on acyclovir is reviewed from a clinical pharmacologist's perspective. Acyclovir pharmacokinetics is accurately described by a two-compartment open model. The volume of distribution at steady state is about two-thirds of the body weight. The half-life of its beta phase of elimination is about three hours with normal renal function and increases to about 18 hours with anuria. Hemodialysis removes about 60 percent of the acyclovir in the body. The pharmacokinetics is independent of dose at least up to 15 mg/kg. Acyclovir is minimally (15 percent) protein-bound an only a small percentage (15 percent) of an intravenous dose is metabolized in persons with normal renal function. Acyclovir is eliminated primarily by glomerular filtration with a small addition from tubular secretion. The toxicity of acyclovir seems to be acceptably low. Local irritation with extravasation exists. Transient glomerular dysfunction is occasionally seen after bolus administration. Other side effects remain to be clearly established.