Acyclovir sodium administered intravenously to treat acute herpes zoster in an immunocompromised patient was associated with side effects as described by Sylvester et al in this issue ofThe Journal. 1 The CASE REPORT raises several important questions: Should acyclovir be used for treatment of herpes zoster, and, if so, what dosage is appropriate and what adverse effects can be expected? Acyclovir is a specific inhibitor of the DNA polymerase of all five members of the human herpesvirus family and thus the drug is potentially useful for treatment of many herpes-virus-associated diseases. The median sensitivity of herpes simplex virus (HSV) type 2 strains to acyclovir as measured by plaque reduction is 0.4μM. 2 Plasma concentrations fivefold higher than this can be attained by ingesting one 200-mg acyclovir capsule. Therefore, it is not surprising that acyclovir is the drug of choice for treatment of primary 3 and recurrent 4 genital herpes, herpes
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Henry H. Balfour (1986) studied this question.