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Advances in molecular virology, with the identification of viral-specific enzymes, led to the development of a number of antiviral agents. Effective antivirals currently are available for the management of infections caused by herpes simplex virus (HSV), varicella-zoster virus (VZV), cytomegalovirus (CMV), hepatitis B and C viruses, influenza A and B viruses, and human immunodeficiency virus (HIV). To maximize therapeutic efficacy, treatment should be initiated as early in the course of infection as possible. Under some circumstances (eg, recurrent herpes simplex virus infections and exposure to influenza virus), antivirals may be effective in the prevention of infection. Development of resistance to antivirals is emerging as a problem, especially in the immunocompromised host population and more recently with influenza viruses circulating in the general population.


Subtle modifications of antiviral compounds have led to the development of drugs with increased bioavailability after oral administration. Many of these drugs are now used extensively in the outpatient setting (Table 245-1). However, severe viral infections, especially in immunocompromised hosts, require aggressive parenteral therapy, often with high doses of antiviral drugs (Table 245-2).1-3

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Table 245-1. Dosages for Oral Antiviral Agents Commonly Used for the Ambulatory Patient 

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