續教育單純疱疹病毒在懷孕期間的 繼Pharmacy Practice 執業藥學感染及治療柳營奇美醫院藥劑科藥師劉純純 陳憲煜摘要 (Herpes simplex virus HSV) HSV-1 HSV-2 acyclovir valacyclovir famciclovir pregnancy herpes simplex virus acyclovir 壹 前言 2 HSV 3 50% 30% 40% 貳 單純疱疹病毒 HSV 一 單純疱疹病毒 1.6 1 1. HSV 2. HSV- 1 HSV-2 3. 30% DNA HSV DNA 4% 100 nm 20% ( ) 藥學雜誌第 111 冊 35
繼續教育執業藥學 Pharmacy Practice 圖一單純疱疹病毒結構圖 HSV-1 4 HSV-2 HSV 2 5 二 流行病學 ( 1-10%) HSV HSV 4 HSV 5 三 對 HSV 的免疫反應 HSV 1. α β-interferons 2. T HSV 6 四 懷孕期間感染疱疹病毒的重要性 ( 一 ) 初次感染 2-14 10-12 HSV ( ) 7 8 表一子宮內及新生兒感染疱疹病毒 36 THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.2
續教育( 二 ) 再發性感染 HSV-2 HSV- 1 100% HSV-2 8-10 ( ) 9 圖二孕婦懷孕期間感染生殖道疱疹對胎兒及新生兒之影響 ( 三 ) 新生兒 HSV 5% HSV 8 50% 90% HSV-2 HSV-1 HSV-2 10 20 HSV 48 11 40-45% 5-10% 90% 繼 () 12 ( ) 13 參 懷孕過程中抗病毒藥物的選擇及安全性 HSV acyclovir valacyclovir famciclovir penciclovir sorivudine brivudine HSV acyclovir valacyclovir famciclovir 一 Acyclovir (Zovirax) HSV acyclovir acyclovir-triphosphate (deoxyguanosine triphosphate) acyclovir-triphosphate DNA 3'hydroxyl group DNA Acyclovir HSV HSV acyclovir 10-15 mg 8 10 Acyclovir 96% acyclovir acyclovir acyclovir 藥學雜誌第 111 冊 37
繼續教育執業藥學 Pharmacy Practice 表二藥物使用 初次感染生殖道疱疹 Acyclovir 5 200 mg 10 days Valacyclovir 2 500 mg 再次感染生殖道疱疹 二 Valacyclovir (Valtrex) 10 days Acyclovir 5 200 mg 5 days Valacyclovir 2 500 mg 生殖道疱疹治療 5 days Acyclovir 3 400 mg Valacyclovir 2 250 mg 新生兒疱疹 靜脈輸注 [2-(2 amino-1,6-dihydro-6-oxo-9hpurine-9yl-methothy) ethyl ester L-valinate hydrochloride,valtrex] L-valylester acyclovir acyclovir valacyclovir acyclovir acyclovir 3-5 valacyclovir valacyclovir acyclovir Valacyclovir acyclovir acyclovir 36 Acyclovir 3 10 15 mg/kg 14 21 days 抑制新生兒再次感染所發生的皮膚性疱疹 Acyclovir 2 3 300 mg/m 2 三 Famciclovir 以及 Penciclovir F a m c i c l o v i r [ 9 - ( 4 h y d r o x y - 3 - hydroxymethylbut l-yl) guanine; Famvir] Famciclovir penciclovir Famiclovir valacyclovir acyclovir 77% deacetylation oxidation famciclovir HSV acyclovir valacyclovir B 3 acyclovir HSV 36 acyclovir 14 ( ) ( ) 肆 結論 HSV acyclovir valacyclovir famciclovir 38 THE JOURNAL OF TAIWAN PHARMACY Vol.28 No.2
續教育表三藥物比較 ( ) Acyclovir 15-30% 3 Valacyclovir 55% (of acyclovir) 3 Famciclovir 77% 3 penciclovir 參考資料 : 1. Brown ZA, Selke S, Zeh J, et al: The acquisition of herpes simplex virus during pregnancy. The New England journal of medicine. 1997; 337: 509-515. 2. Kimberlin DW, Lin CY, Jacobs RF, et al: Safety and efficacy of high-dose intravenous acyclovir in the management of neonatal herpes simplex virus infections. Pediatrics. 2001; 108: 230-238. 3. Hutto C, Arvin A, Jacobs R, et a: Intrauterine herpes simplex virus infections. The Journal of pediatrics. 1987; 110: 97-101. 4. Whitley RJ. Herpes simplex virus infections of the central nervous system. A review. The American journal of medicine. 1988; 85: 61-67. 5. Randolph AG, Washington AE, Prober CG. Cesarean delivery for women presenting with genital herpes lesions. Efficacy, risks, and costs. Jama. 1993; 270: 77-82. Abstract 6. Desselberger U. Herpes simplex virus infection in pregnancy: diagnosis and significance. Intervirology. 1998; 41: 185-190. 7. Fonseca-Aten M, Messina AF, Jafri HS, et al: Herpes simplex virus encephalitis during suppressive therapy with acyclovir in a premature infant. Pediatrics. 2005; 115: 804-809. 8. Avgil M, Ornoy A. Herpes simplex virus and Epstein-Barr virus infections in pregnancy: consequences of neonatal or intrauterine infection. Reproductive toxicology (Elmsford, N.Y. 2006; 21:436-445. 9. Sauerbrei A, Wutzler P. Herpes simplex and varicellazoster virus infections during pregnancy: current concepts of prevention, diagnosis and therapy. Part 1: herpes simplex virus infections. Medical microbiology and immunology. 2007; 196: 89-94. 10. Brown ZA, Gardella C, Wald A, et al: Genital herpes complicating pregnancy. Obstetrics and gynecology. 2005; 106: 845-856. 11. Kimberlin DW. Neonatal herpes simplex infection. Clinical microbiology reviews. 2004; 17: 1-13. 12. Spruance SL. Pathogenesis of herpes simplex labialis: excretion of virus in the oral cavity. Journal of clinical microbiology. 1984; 19: 675-679. 13. Taddio A, Klein J, Koren G. Acyclovir excretion in human breast milk. The Annals of pharmacotherapy. 1994; 28: 585-587. 14. Pacifici GM. Transfer of antivirals across the human placenta. Early human development. 2005; 81: 647-654. HSV Infection and Treatment During Pregnancy Chun-Chun Liu, Hsien-Yu Chen Department of Pharmacy, Chi Mei Medical Center, Liouying Herpes simplex virus (HSV) is one of the most important pathogen in human and is closely related to many clinical diseases, such as cold sores, keratoconjunctivitis, meningitis, genital herpes and so on. A fetus being infected with HSV through the placenta by an infected mother could be fetal and causing a miscarriage. In addition, it also causes fetal abnormalities of growth and development in the womb or severe neonatal diseases after the birth. HSV- 1 and HSV-2 would infect ganglion and root in it whether there are clinical manifestations or not when they invade the epidermal or dermal cells. Anti-herpes virus agents include acyclovir and its prodrugs, valacyclovir and famciclovir. This article describes the selection and safety of those anti-viral agents during pregnancy. 藥學雜誌第 111 冊 39 繼