Mj. Wood et al., A RANDOMIZED TRIAL OF ACYCLOVIR FOR 7 DAYS OR 21 DAYS WITH AND WITHOUT PREDNISOLONE FOR TREATMENT OF ACUTE HERPES-ZOSTER, The New England journal of medicine, 330(13), 1994, pp. 896-900
Background. Acyclovir given for 7 to 10 days is of proved benefit in a
cute herpes tester, but studies of its effectiveness in preventing pos
therpetic neuralgia have had conflicting results. The role of corticos
teroids in the treatment of herpes tester is also controversial. Metho
ds. We conducted a double-blind, controlled trial in patients with acu
te herpes tester to determine whether either 21 days of acyclovir ther
apy or the addition of prednisolone offered any improvement over 7 day
s of acyclovir therapy. Patients with a rash of less than 72 hours' du
ration were assigned to receive acyclovir (800 mg orally, five times d
aily) for 7 days with either prednisolone or placebo, or acyclovir for
21 days with either prednisolone or placebo. Prednisolone therapy was
initiated at a dose of 40 mg per day and tapered over a three-week pe
riod. Patients were assessed frequently through day 28 and then monthl
y through month 6 to assess postherpetic neuralgia. Results. Of 400 pa
tients recruited, 349 completed the study. No significant differences
were detected between the four groups in the progression of the rash (
P>0.1). With steroid therapy, a significantly higher proportion of the
rash area had healed on days 7 and 14 (P = 0.02). Pain reduction was
greater during the acute phase of disease in patients treated with ste
roids or 21 days of acyclovir(P<0.01 and P = 0.02, respectively, on da
y 7; P<0.01 for steroid therapy on day 14). However, on follow-up ther
e were no significant differences between any of the groups in the tim
e to a first or a complete cessation of pain. The steroid recipients r
eported more adverse events. Conclusions. In acute herpes tester, trea
tment with acyclovir for 21 days or the addition of prednisolone to ac
yclovir therapy confers only slight benefits over standard 7-day treat
ment with acyclovir. Neither additional treatment reduces the frequenc
y of postherpetic neuralgia.