Neue Virustatika

Zusammenfassung

Die Zahl der verfügbaren oder kurz vor der Zulassung stehenden Virustatika wächst kontinuierlich. Neben den antiretroviralen Präparaten zur Behandlung der HIV-Infektion liegt der Schwerpunkt auf Präparaten mit Aktivität gegen Mitglieder der Familie der Herpesviridae, insbesondere das Varicella-zoster-Virus und das Herpes-simplex-Virus. Die Studienlage bezüglich der antiviralen Behandlung viraler Infektionen des Nervensystems ist unbefriedigend. Einzig für die Therapie des Herpes zoster liegen mehrere kontrollierte Studien vor. Diese Studien deuten darauf hin, dass durch Einsatz neuer Virustatika wie des Famciclovir oder des Valaciclovir der akute Zosterschmerz schneller sistiert und die Rate an Post-zoster-Neuralgien sinkt. Für die Therapie der viralen Enzephalitiden existieren in der Regel nur Einzelfallberichte. Dennoch bietet das erweiterte Spektrum an antiviral wirksamen Substanzen auch bei der viralen Enzephalitis die Möglichkeit, im Einzelfall Präparate einzusetzen, die zumindest in vitro eine Aktivität gegen das kausale Pathogen entfalten. Bei der Herpes-simplex-Enzephalitis bleibt Aciclovir das Mittel der ersten Wahl.

Abstract

The number of available antiviral drugs increases constantly. Beyond antiretroviral compounds with activity against HIV, most of the recently introduced virustatic drugs unfold their activity against members of the Herpesvirus family, especially herpes-zoster- and herpes-simplex viruses. However, controlled studies on viral infections of the nervous system are rare, perhaps with the one exception of herpes zoster. Some studies on herpes zoster indicate that with modern antiviral substances like famiciclovir or valaciclovir acute zoster pain and post zoster neuralgia may be shortened in duration and reduced in frequency. Concerning the antiviral treatment of encephalitis with new virustatics, our experience is mainly based on case reports. Nevertheless, the broader spectrum of antiviral substances offers the possibility to treat individual encephalitis patients with drugs that have at least in vitro activity against the causative virus. In herpes-simplex-encephalitis, aciclovir remains the antiviral drug of first choice.

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