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The varicella zoster virus is more virulent than the herpes simplex virus, so we prescribe standard dosing for shingles and half-dosing for herpetic eye disease. For acyclovir, the shingles dosage is 800mg five times daily for one week; thus, for herpes simplex, the dosing would be 400mg five times daily for one week. For valacyclovir (original brand name Valtrex), the shingles dosage is 1000mg three times daily for one week; the herpes simplex dosage is 500mg three times daily for one week. In like manner, the dosing of generic famciclovir (former brand name Famvir) is 500mg three times daily for shingles, and is 250mg three times daily for herpes simplex. While the brand-name drug has been discontinued, generic famciclovir is available. Famciclovir is recommended for the over-65 population because of enhanced tolerability, although all three drugs do perform quite well. 1. Lyon RC, Taylor JS, Porter DA, et al. Stability profiles of drug products extended beyond labeled expiration dates. J Pharma Sci. 2006;95(7):1549-60. 2. Paauw, D.S. & Deye, D. L. Practical Reviews in Ophthalmology, Volume 40-10, 2019. SECTION II: ANTERIOR SEGMENT CARE AMOXICILLIN/CLAVULANIC ACID (AUGMENTIN) • Clavulanic acid enables amoxicillin to be bactericidal against common grampositive pathogens • Useful in treating soft tissue infections • Cannot use if patient is allergic to penicillin • Tx: 250mg, 500mg & 875mg (generic) or 1000mg (branded only) tablet q12hrs x 7-10 days • Can be taken with meals QUESTIONS COLLEAGUES ASK… Q“Do you recommend a specific probiotic when you prescribe doxycycline? I know it has a low-risk profile, but a few patients of mine have developed Clostridium difficile (C. Diff infection). AAs usual, we consulted authoritative literature to gain an answer: “Comparison of findings from the American College of Gastroenterology, the association for professionals in infection control and epidemiology, and the European Society of Clinical Microbiology and Infectious Diseases, does not recommend probiotic prophylaxis when antibiotics are prescribed, citing insufficient evidence.”1 Our take: Exceedingly rarely have we ever recommended concurrent use of a probiotic with any oral antibiotic.
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