Case 2: Acyclovir-Resistant Herpes Simplex Virus Infection

Case-Based Modules
Initial Evaluation
Dermatologic Manifestations
Oral Manifestations
OIs: Prophylaxis
OIs: Treatment
Antiretroviral Rx
Antiretroviral Rx: Resistance
Antiretroviral Rx: Adverse Effects
Drug-Drug Interactions
Postexposure Prophylaxis
Perinatal Transmission
Special Populations
Prevention for Positives
Challenging Unknowns
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Question | Discussion | References | CME Credit

You answered:

	Valacyclovir (Valtrex) 1000 mg PO tid.

This answer is incorrect. Valacyclovir (Valtrex) is an acyclovir prodrug (it is the L-valine ester of acyclovir). Following absorption of valacyclovir, it is almost completely converted to acyclovir during first-pass hydrolysis in the liver and intestines. Although oral valacyclovir has a relative bioavailability 3 to 5 times greater than acyclovir (and oral doses can generate relatively high serum levels of acyclovir), it would not likely override the acyclovir resistance.

	Acyclovir (Zovirax) 10 mg/kg IV q8h.
	Famciclovir (Famvir) 500 mg PO tid.
	Foscarnet (Foscavir) 40 mg/kg IV q8h.

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