Management Of Resistant Infections

The first way to manage ACV-resistant HSV infection is, when possible, to decrease immunosuppressive treat-ments.[15] An increase of antiviral dose should also be considered.[16]

Several alternative antiviral drugs are also available. Penciclovir is a nucleoside analogue of guanosine and is very similar to ACV. Indeed, most ACV-resistant HSV isolates are also resistant to penciclovir. Foscarnet, a pyrophosphate analogue, and cidofovir, a nucleotide analogue of cytidine, act directly on viral DNA polymerase without previous activation by viral TK and both these molecules are active on viruses resistant to ACV because of a mutation in the TK gene.[17,18] Acyclovir-resistant management strategies usually recommend the use of foscarnet as a first line treatment and cidofovir in case of failure of foscarnet.[16] However, in clinical practice, both of these drugs may be associated with a significant level of toxicity.

Cross-resistance between ACV and foscarnet has been documented in immunocompromised patients.[19-21] Nevertheless, foscarnet-resistant strains sensitive to ACV have also been reported.[21] Acyclovir-resistant strains, cross resistant or not to foscarnet, have always been shown to be sensitive to cidofovir.[9,22] In addition, resistance to cidofovir, never reported so far in clinical strains, has only been described in strains selected in

vitro.

Getting Started With Dumbbells

Getting Started With Dumbbells

The use of dumbbells gives you a much more comprehensive strengthening effect because the workout engages your stabilizer muscles, in addition to the muscle you may be pin-pointing. Without all of the belts and artificial stabilizers of a machine, you also engage your core muscles, which are your body's natural stabilizers.

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