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Title Valacyclovir Prophylaxis Prevents Recurrent Herpes Simplex Virus
Clinical Question Will the prophylactic administration of an anti-viral agent in comparison to placebo, prevent dental-procedure-related recurrence of herpetic infections?
Clinical Bottom Line Valacyclovir prophylaxis suppressed the recurrence of dental-procedure-associated HSV infections.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 15493396Miller/2004125 Healthy HSV-seropositive adults with recurrent herpes labialisRCT
Key resultsAfter a dental procedure, 11.3 percent of patients with valacyclovir had developed herpes lesions compared to 27 percent in the placebo group (p=.026). The mean pain reduction was significantly less in the valacyclovir group compared to the placebo group (p=.006).
Evidence Search ("valacyclovir" [Supplementary Concept]) AND "Stomatitis, Herpetic"[Mesh]
Comments on
The Evidence
Miller’s article is a double-blind, randomized controlled trail. Patients with immuno-suppression and liver dysfunction, and pregnant patients were excluded from the study. 150 patients were enrolled and 125 completed the study for a completion rate of >80%.
Applicability The prophylactic administration of valacyclovir is a practical approach to the prevention of dental procedure-associated recurrent HSV infections. Patients who were given valacyclovir experienced fewer recurrences and reduced symptoms of recurrent HSV infection after dental treatment. Some patients in the treatment group reported mild headaches.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (Endodontics) (General Dentistry) (Oral Surgery) (Periodontics) (Restorative Dentistry)
Keywords recurrent herpes simplex, valacyclovir
ID# 2196
Date of submission: 04/04/2012spacer
E-mail kaurs4@livemail.uthscsa.edu
Author Sukhman Kaur
Co-author(s) e-mail
Faculty mentor/Co-author Geza Terezhalmy, DDS
Faculty mentor/Co-author e-mail terezhalmy@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Surina Odhav, Nicole Conlee (San Antonio, TX) on 11/28/2017
The PubMed and TRIP databases were searched for the above terms, and the article discussed in this CAT was confirmed as the highest level of evidence published on this specific topic at this time. The study by Miller et al., (2004, PMID# 15493396) was a randomized controlled trial sampling 125 people with a completion rate over 80% which found that dental-treatment-related herpetic recurrence is suppressed by vancyclovir prophylaxis. However, a prospective multicenter study on ocular herpetic lesion recurrence (Rousseau et al., 2017, PMID# 28939476) does not support the use of anti-viral prophylaxis due to possible resistance and failed prophylaxis. Further research of this or a higher level specifically on oral-herpetic lesion recurrence is needed to gain more confidence in the findings of the Miller et al. article.

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