2/20/2023 0 Comments Nystatin swish and spitFamciclovir dosing for patients on dialysis: 250mg after each dialysis.ĭisp: Dispensed for 6 months to 1 year according to the patient’s immunity Famciclovir dosing for Herpes Zoster with GFR : 250mg q24h.ĥ. Famciclovir dosing for Herpes Zoster with GFR : 500mg q24h.Ĥ. Famciclovir dosing for Herpes Zoster with GFR : 500mg q12h.ģ. Famciclovir Herpes Zoster Rx: 500mg every 8 hours x 7 days.Ģ. GFR 10-25mL/minute or s.creatinine >3mg/dL to predialysis:ġ. 5-day therapy with kidney disease: GFR 3mg/dL to predialysis: 1g q24hĪ. Sig: 1 capsule q4h while awake or take 5 capsules per day. Table 48.1 Prescriptions Management of Oral Lesions in the Immune-Competent and the Immune-Compromised Patient Infection/Lesion Medication(s) ģ. Oral lesions occur in 30–80% of the affected patient population and highly active antiretroviral therapy (HAART) has decreased the incidence, frequency, and severity of most, but not all, HIV-associated oral lesions. Oral viral leukoplakia (OVL) or hairy leukoplakia (HL), HIV-gingivitis, HIV-periodontitis, HIV necrotizing stomatitis, Kaposi’s sarcoma, cytomegalovirus, or papilloma virus infections are found only in the HIV/AIDS patient. Oral herpes simplex or zoster, oral and/or esophageal candidiasis, angular chilities, xerostomia, and aphthous ulcers can affect the immune-competent or the immune-compromised patient. The oral lesions have a tendency to recur more often with reduction of immunity, and in the HIV patient it can herald the start of the symptomatic phase. In spite of tremendous advances in antiretroviral therapy, oral lesions do occur and they must be appropriately managed. Recurrence of oral lesions following resolution in the HIV/AIDS patient can indicate failure of oral lesion therapy or worsening of the HIV infection. The oral lesions can resolve with improvement of the patient’s immunity following antiretroviral treatment. The physician will evaluate the patient’s current health status, including the CD 4 count and the viral load, to determine if antiretroviral treatment is necessary. When treating an HIV patient, the dentist must refer a formerly asymptomatic, untreated, known HIV patient to the physician upon discovery of new oral lesions. However, once confirmed, the underlying cause or disease state should be addressed and appropriately managed along with the care of the oral lesions. With the presence of oral lesions, the clinician must assess the medical history and decide if appropriate laboratory tests need evaluation to confirm the presence or absence of all causes of decreased immunity, including HIV infection. Thus, presence of oral lesions by themselves is not diagnostic of HIV infection or other causes of decreased immunity. Stress, chronic corticosteroid therapy, severe sun exposure, and broad-spectrum antibiotic use are often the cause of oral lesions in the immune-competent patient. Immunity can be compromised because of many factors including HIV/AIDS, chemotherapy, radiotherapy, leukemias, lymphomas, connective tissue disorders, and poorly controlled diabetes. However, the severity and duration often differ. The common oral lesions seen in the immune-competent and the immune-compromised patient will be collectively discussed because many of the lesions in the two populations overlap. Therapeutic Management of Oral Lesions in the Immune-Competent and the Immune-Compromised Patient in the Dental Setting
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