|Year : 1992 | Volume
| Issue : 4 | Page : 243-245
Comparison of therapeutic efficacy of Acyclovir 5% cream with silver Sulphadiazine 1% cream in herpes zoster
B Rao Prasanna, Jerome Pinto, Kamat
B Rao Prasanna
Source of Support: None, Conflict of Interest: None
The effects of acyclovir 5% cream and silver sulphadiazine 1% cream were compared in 2 groups of patients of herpes zoster. Acyclovir cream was more beneficial only when used within the first 3 days or when the lesions were still predominantly papular. In the later stages silver sulphadiazine cream was effective.
Keywords: Acyclovir, Silver sulphadiazine, Herpes zoster
|How to cite this article:|
Prasanna B R, Pinto J, Kamat. Comparison of therapeutic efficacy of Acyclovir 5% cream with silver Sulphadiazine 1% cream in herpes zoster. Indian J Dermatol Venereol Leprol 1992;58:243-5
|How to cite this URL:|
Prasanna B R, Pinto J, Kamat. Comparison of therapeutic efficacy of Acyclovir 5% cream with silver Sulphadiazine 1% cream in herpes zoster. Indian J Dermatol Venereol Leprol [serial online] 1992 [cited 2019 Jun 16];58:243-5. Available from: http://www.ijdvl.com/text.asp?1992/58/4/243/3807
| Introduction|| |
Acyclovir (topical, oral, parenteral) ,, has now been accepted as the antiviral of first choice in herpes zoster. The usefulness of silver sulphadiazine (SS) cream topically in zoster has been demonstrated in earlier studies.  The present study aims at comparing the efficacy of the two.
| Material and Methods|| |
One hundred patients of herpes zoster entered the study (between February 1990 and October 1991), 18 of them were later excluded for want of adequate follow up. Thirty seven were treated with acyclovir 5% cream, applied 5 times a day and 45 with silver sulphadiazine 1 % cream, applied 4 times a day. They were asked to return for follow up, at least once in 3 days. The complaints and morphology of lesions at each follow up were noted. The number of days that the individual type of lesions (papule, vesicle, pustule, crusting, erosion) lasted, and the total duration of the acute disease (until all erosions healed) was calculated for each patient.
| Results|| |
[Table - 1] compares the response of individual types of lesions to the 2 treatments. Since the patients entered the study at different stages of their disease their response to treatment differed. [Table - 2] compares the responses depending upon the day of the disease on which treatment was started and [Table - 3] compares the response in the 2 groups depending upon the predominant type of lesion at the start of treatment.
Student `t' test was used to find out the P value.  The P value was < 0.05 only when acyclovir was started within the first 3 days or when the lesions were still predominantly papular.
| Comments|| |
Acyclovir ,,sub is currently a popular antiviral drug in the treatment of Herpes virus infections. It is a guanosine analogue. The drug is rapidly converted to acyclovir monophosphate by the viral thymidine kinase in the infected cells. This is then converted to disphosphate and then to triphosphate (ATP) by the host kinases. ATP inhibits the viral DNA polymerase and also causes irreversible chain termination by competing with guanosine. Topical acyclovir has been found useful in zoster.  Montes et a1[ 4] have reported the usefulness of silver sulphadiazine in treatment of zoster and suggested that silver ions probably inactivated the virus, as was demonstrated by an in vitro study.
However no direct comparison between the 2 drugs has been reported. Our study has shown that there is insignificant overall difference between the duration of zoster in the 2 groups. It was however observed that when acyclovir was started within the first 3 days of the disease, the healing time was significantly (P < 0.05) less than that of the silver sulphadiazine treated group. Papules and vesicles appeared to subside more rapidly when acyclovir was used. In the case of papules the difference, was significant (P < 0.05) where as there was no significant difference in the healing time of the other types of lesions. Also the zoster subsided significantly faster when acyclovir was used when the lesions were still predominantly papular.
The disadvantage of acyclovir is that it is expensive when compared to SS cream. It is therefore clear that acyclovir is not cost-effective in all patients. Its use should be restricted to the immunocompromised patients and the early stages of the disease. Cheaper, costeffective alternatives such as silver sulphadiazine should be used in all other cases.
| References|| |
|1.||Huffe J. Antiviral treatment in chickenpox and herpes zoster, J Am Acad Dermatol 1988; 18 204-6. |
|2.||Levin M J, Zaia J A, Hershey B J, et al. Topical acyclovir treatment of herpes zoster in the immunocompromised patients. J Am Acad Dermatol 1985; 13: 590-6. |
|3.||Douglas R F Jr. Antimicrobial agents : antiviral agents. In : Goodman and Gilman's The Pharmacological basis of Therapeutics (Gilman A B, Rail T W, Nies AS, Taylor P, eds), 8th edn. New York : Pergamon press, 1990; 1182-201. |
|4.||Montes L F, Muchinik G, Fox C L. Response of varicella zoster virus and herpes zoster to silver sulphadiazine. Cutis 1986; 38, 363 - 5 |
|5.||Mahajan B K. Methods in biostatistics for medical students and research workers, 5th edn. New Delhi : Jaypee brothers, 1989; 115-55. |
[Table - 1], [Table - 2], [Table - 3]