Use of aciclovir in general practice: experience in a practice in the north-east of England.
Use of aciclovir in general practice: experience in a practice in the north-east of England. |
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Key words: herpes virus infections; antiviral treatment.
Introduction
On several occasions, patients present with oral or genital symptoms which give
the impression of herpetic infections. A few of these patients give information
that they have had this condition before and only demand a prescription. Often
aciclovir cream is prescribed but sometimes when the condition is severe,
tablets are prescribed. This study was done to review the management of patients
who were prescribed aciclovir in our general practice. Our practice consists of
six doctors, two females and four male. The size of the practice is 12,000 (1).
Patients and methods
Using the practice computer, details of all patients (men and women) who were
prescribed aciclovir for any condition were extracted. The only anti-herpetic
drugs in the practice were Zovirax/aciclovir cream and tablets. Throughout the
research, there were no prescriptions for Famvir or any other anti-herpetic
drugs found. The period of study was between 1st January 2000 and 31st December
2000. These notes were carefully analysed.
Results
The computer generated 120 different patients who had been given aciclovir
during this period. Among these patients twenty-three were below the age of
sixteen and they are excluded. Of the remaining 97, there were 67 females and 30
males. The results are shown in table 1 and figure 1. In the diagnoses, 14
(46.7%) men had oral cold sores, 14 (46.7%) were diagnosed with shingles and 2
(6.6%) had genital herpes. In the case of the females, 50 (74.6%) had oral cold
sores, 14 (20.9%) had shingles, and 3 (4.5%) had genital herpes. As for
treatment, 13 men (43.3%) had tablets, 15 (50%) were prescribed cream; and 2
(6.7%) were prescribed tablets and cream. In the case of the females, 18 (29.6%)
received tablets, 48 (71.6%) received cream and 1 (1.5%) received tablets and
cream. Nearly all the men who were diagnosed with shingles were prescribed
tablets and those who had oral cold sores had cream. However, all those who had
genital herpes had tablets and cream. As for the females, only half of those who
had shingles were prescribed tablets and all those with oral cold sores had
cream. One woman who had genital herpes received tablets and cream while the
other two only had cream.
Discussion
In the diagnoses, mainly there were three types of presentations: oral herpes
simplex infections, genital herpes simplex infections; and the third
presentation was herpes zoster. Generally the patients expectation for oral cold
sores is creams and quite often the patients are happy to have this
prescription. For herpes zoster, some patients do expect oral treatment, and for
genital herpes, the patients are happy to follow the doctor`s advice. The
inclination is to use more cream than the tablets in view of the costs. The cost
of Zovirax cream on average is £5.29 per 2gm tube and £15.94 for the 10gm tube.
For the Zovirax 800 mg tablets (35 tablets), the cost is £75.11 and for 200 mg
tablets (25 tablets), the cost is £20.22. For generic aciclovir the cost is
cream £2.91 per 2 gm tube and £11.38 for the 10gm tube. For aciclovir tablets,
800 mg (35 tabs), the cost is £15.99 and for 200 mg (25 tabs), the cost is
£5.17(2).
Looking at the generic aciclovir costs, the tablets, especially 200 mg (25 tabs) are cheaper than the10 mg cream. Also the overall result and period of remission is better with the tablets. Therefore in the long run, from both the patient`s point of view and the cost point of view, it makes sense to use tablets rather than the cream. There is no place for aciclovir cream in the management of genital herpes.
Table 1
Fig 1
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