Opstelten Wim, Eekhof Just, Neven Arie Knuistingh, Verheij Theo
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Can Fam Physician. 2008 Mar;54(3):373-7.
To review the evidence regarding treatment of herpes zoster (HZ) in the short-term, focusing on the prevention of postherpetic neuralgia (PHN).
The evidence relating to treatment of HZ is derived mainly from randomized controlled trials (level I evidence).
Antiviral drugs might have some effect on the severity of acute pain and on the duration of skin lesions. Corticosteroids also alleviate acute pain. Oral antiviral medication reduces the risk of eye complications in patients with ophthalmic HZ. There is no convincing evidence that antiviral medication reduces the risk of PHN. Some studies, however, have shown that famciclovir and valacyclovir shorten the duration of PHN. The effectiveness of amitriptyline or cutaneous and percutaneous interventions in preventing PHN has not been proven.
Oral antiviral drugs should be prescribed to elderly HZ patients with high risk of PHN. Moreover, these drugs should be prescribed to all patients at the first signs of ophthalmic HZ, irrespective of age or severity of symptoms.
回顾关于带状疱疹(HZ)短期治疗的证据,重点关注带状疱疹后神经痛(PHN)的预防。
与HZ治疗相关的证据主要来自随机对照试验(I级证据)。
抗病毒药物可能对急性疼痛的严重程度和皮肤损害的持续时间有一定作用。皮质类固醇也可减轻急性疼痛。口服抗病毒药物可降低眼部HZ患者发生眼部并发症的风险。没有令人信服的证据表明抗病毒药物可降低PHN的风险。然而,一些研究表明,泛昔洛韦和伐昔洛韦可缩短PHN的持续时间。阿米替林或皮肤及经皮干预措施在预防PHN方面的有效性尚未得到证实。
对于有高PHN风险的老年HZ患者应开具口服抗病毒药物。此外,对于所有出现眼部HZ首发症状的患者,无论年龄或症状严重程度如何,均应开具这些药物。