A patient with HIV contracts herpes simplex virus (HSV), and the prescriber orders acyclovir [Zovirax] 400 mg PO twice daily for 10 days. After 7 days of therapy, the patient reports having an increased number of lesions
The nurse will expect the provider to: a. extend this patient's drug therapy to twice daily for 12 months.
b. give intravenous foscarnet every 8 hours for 2 to 3 weeks.
c. increase the acyclovir dose to 800 mg PO 5 times daily.
d. order intravenous valacyclovir [Valtrex] 1 gm PO twice daily for 10 days.
B
Foscarnet is active against all known herpesviruses and is used in immunocompromised patients with acyclovir-resistant HSV or VZV. This patient is demonstrating resistance to acyclovir, so extending acyclovir therapy or increasing the acyclovir dose will not be effective. Valacyclovir is not approved for use in immunocompromised patients because of the risk for thrombotic throm-bocytopenic purpura/hemolytic uremic syndrome.
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