Novel Insights to Enhance Therapeutics With Acyclovir in the Management of Herpes Simplex Encephalitis.

Acyclovir is an antiviral drug poorly absorbed in the gastrointestinal tract due to its hydrophilicity, with low oral bioavailability (~20%). Although acyclovir is prescribed in the management of herpes simplex encephalitis (HSE), the disease has a poor prognosis, particularly if the treatment is delayed, reaching mortality rates of 70% if left untreated. Thus, high acyclovir doses are administered by intravenous (IV) infusion, usually at a dosage of 10 mg kg-1 8-hourly in adults with normal renal function. However, the mortality related to HSE treated with acyclovir remains high (~20%) and permanent sequelae are commonly reported after 1 year (~50%). This review analyzed clinical trials following IV acyclovir administration. Novel insights aiming to improve drug bioavailability were reviewed, including acyclovir or its prodrugs, leading to the systemic distribution of the drug or drug targeting. Much research effort has been made to improve antiviral therapy, searching for delivery systems increasing acyclovir bioavailability by non-invasive pathways, such as oral and nasal pathways, or parenterally administered nanotechnology-based systems leading to drug targeting. Nanocarriers administered by non-invasive pathways represent feasible alternatives to treat HSE, even though not be industrially manufactured yet. Copyright © 2021 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Citation

Maria Silvia Gurgel Assis, Taciane Cristina Fernandes Pedrosa, Fernanda Segurasse de Moraes, Tamires Guedes Caldeira, Gislaine Ribeiro Pereira, Jacqueline de Souza, André Luís Morais Ruela. Novel Insights to Enhance Therapeutics With Acyclovir in the Management of Herpes Simplex Encephalitis. Journal of pharmaceutical sciences. 2021 Apr;110(4):1557-1571

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PMID: 33450220

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