Integrated Clinics

Integrated Clinics INTEGRATED COURSE Clinics MEC-251M COURSE OF INFECTIOUS DISEASES PROFESSOR IN CHARGE Dr. Carlos Perez C. SCHEDULE P5 room Monday to Friday from 14:30 to 17:30 Hrs. S. Sem. 8, 7 and 6 on Monday, Tuesday, Thursday and Friday S.

Sem. 8, 7 Wednesday DATES (13 evenings for groups) Group 1: 6/3 to 22/3 Group 2: 19/4 to 8/5 Group 3: 4/6 to 21/6 OBJECTIVES Learn the basics of microbial taxonomy, identification techniques of infectious agents and methods of study of antimicrobial susceptibility. Recognize the clinical and laboratory features for the diagnosis of the most common infections in healthy and immunocompromised host. Knowing the pharmacokinetic and pharmacodynamic characteristics of the main antimicrobial agents and their indications in prevalent infections in ambulatory and hospital practice. Know the main bibliographical sources used in the field. FACULTY

Dr. Guillermo Acuña. Dr. Jaime Labarca Dr. Luis M. Noriega Dr. Carlos Perez Dr. Jorge Pérez Dr. Paul Vial

Dra. Enna Zunino Dr. Mario Salcedo Dra. Marisa Torres Other teachers Hospital Lucio Córdova (Seminars) BIBLIOGRAPHY It will be delivered at the beginning of the course. EVALUATION Seminar notes (20%) and written exam (80%) FIRST GROUP CALENDAR: March 6 to March 22 Tuesday

6 1 Febrile syndrome Dr. Guillermo Acuña 2 Laboratory diagnosis of infectious diseases. Antimicrobial susceptibility studies. Dr. Jaime Labarca Wednesday 7 1

Epidemiology, pathogenesis, evolution and treatment of HIV infection. Dr. Carlos Perez 2 Prevention and treatment of opportunistic infections in HIV infection Dr. Luis M. Noriega Thursday 8 1 Nosocomial infections. Universal Precautions.

Dr. Jaime Labarca 2 Concept of cyclic and noncyclic septicemias. Typhoid fever. Brucellosis. Salmonella enteritidis Dr. Jaime Labarca Friday 9 1 Herpes virus infections: Herpes simplex, Varicella zoster, Epstein Barr, Cytomegalovirus.

Dr. Paul Vial 2 Seminar: mononucleosis syndrome Dr. Jaime Labarca Dr. Carlos Perez Dr. Paul Vial Monday 12 1

Antibiotics Class: General highlights pharmacokinetic, pharmacodynamic and indications of major groups Dr. Carlos Perez 2 Upper respiratory infections: Tonsillopharyngitis, otitis, sinusitis. Dr. Paul Vial Tuesday 13 *1 Infections of the central nervous system (CNS) Dr. Luis M.

Noriega I: Meningitis clear liquid, purulent meningitis. *2 Seminar: lower respiratory infections: Dr. Luis M. Noriega Classical and atypical bacterial pneumonia. Dr. Carlos Perez Dra. Patricia González Wednesday

14 1 bone and joint infections Dr. Guillermo Acuña 2 Sexually transmitted infections. Dr. Guillermo Acuña Thursday fifteen 1 Streptococcus and staphylococcus infections.

Dr. Jorge Pérez 2 rash diseases and more frequent in the adult Vesicular: Measles, Rubella, Varicella. Dra. Marcela Ferres Friday 16 1 CNS infections II: encephalitis, brain abscess. Dr. Carlos Perez 2

Seminar: Clinical cases on use of antibiotics Dr. Carlos Perez Dr. Jaime Labarca Monday 19 *1 Infections of skin and soft tissue Dr. Carlos Perez *2 Seminar: Intra-abdominal infections

Dr. Carlos Perez Tuesday twenty 1 Infections in immunosuppressed Dr. Jaime Labarca 2 Seminar: Infections in immunosuppressed Dr. Jaime Labarca Dr.

Carlos Perez Wednesday twenty-one 1 Fascioliasis, hydatidosis, trichinosis, cysticercosis, toxocariasis, toxoplasmosis: frequently in clinical practice Histoparasitosis. Dra. Marisa Torres Thursday 22 1 Evaluation Dr. Carlos Perez

* Module Teaching Hospital Sotero del Rio UDA SECOND GROUP CALENDAR: April 19 to May 8 Thursday 19 1 Febrile syndrome Dr. Guillermo Acuña 2 Laboratory diagnosis of infectious diseases. Antimicrobial susceptibility studies. Dr. Jaime Labarca

Friday twenty 1 Epidemiology, pathogenesis, evolution and treatment of HIV infection. Dr. Carlos Perez 2 Prevention and treatment of opportunistic infections in HIV infection Dr. Luis M. Noriega Monday 2.

3 1 Nosocomial infections. Universal Precautions. Dr. Jaime Labarca 2 Concept of cyclic and noncyclic septicemias. Typhoid fever. Brucellosis. Salmonella enteritidis Dr. Jaime Labarca


Tuesday 24 1 Herpes virus infections: Herpes simplex, Varicella zoster, Epstein Barr, Cytomegalovirus. Dr. Paul Vial 2 Seminar: mononucleosis syndrome Dr. Jaime Labarca Dr. Carlos Perez Dr.

Paul Vial Wednesday 25 1 Antibiotics Class: General highlights pharmacokinetic, pharmacodynamic and indications of major groups Dr. Carlos Perez 2 Upper respiratory infections: Tonsillopharyngitis, otitis, sinusitis. Dr. Paul Vial Thursday 26

*1 Infections of the central nervous system (CNS) Dr. Luis M. Noriega I: Meningitis clear liquid, purulent meningitis. *2 Seminar: lower respiratory infections: Dr. Luis M. Noriega Classical and atypical bacterial pneumonia. Dr.

Carlos Perez Dra. Patricia González Friday 27 1 bone and joint infections Dr. Guillermo Acuña 2 Sexually transmitted infections. Dr. Guillermo Acuña

Monday 30 1 Streptococcus and staphylococcus infections. Dr. Jorge Pérez 2 rash diseases and more frequent in the adult Vesicular: Measles, Rubella, Varicella. Dra. Marcela Ferres Wednesday 2 1

CNS infections II: encephalitis, brain abscess. Dr. Carlos Perez 2 Seminar: Clinical cases on use of antibiotics Dr. Carlos Perez Dr. Jaime Labarca Thursday 3 *1 Infections of skin and soft tissue

Dr. Carlos Perez *2 Seminar: Intra-abdominal infections Dr. Carlos Perez Friday 4 1 Infections in immunosuppressed Dr. Jaime Labarca 2

Seminar: Infections in immunosuppressed Dr. Jaime Labarca Dr. Carlos Perez Monday 7 1 Fascioliasis, hydatidosis, trichinosis, cysticercosis, toxocariasis, toxoplasmosis: frequently in clinical practice Histoparasitosis. Dra. Marisa Torres Tuesday 8

1 Evaluation Dr. Carlos Perez * Module Teaching Hospital Sotero del Rio UDA SCHEDULE THIRD GROUP: June 4 to June 21 Monday 4 1 Febrile syndrome Dr. Guillermo Acuña 2

Laboratory diagnosis of infectious diseases. Antimicrobial susceptibility studies. Dr. Jaime Labarca Tuesday 5 1 Epidemiology, pathogenesis, evolution and treatment of HIV infection. Dr. Carlos Perez 2 Prevention and treatment of opportunistic infections in HIV infection Dr.

Luis M. Noriega Wednesday 6 1 Nosocomial infections. Universal Precautions. Dr. Jaime Labarca 2 Concept of cyclic and noncyclic septicemias. Typhoid fever. Brucellosis.

Salmonella enteritidis Dr. Jaime Labarca Thursday 7 1 Herpes virus infections: Herpes simplex, Varicella zoster, Epstein Barr, Cytomegalovirus. Dr. Paul Vial 2 Seminar: mononucleosis syndrome Dr. Jaime Labarca

Dr. Carlos Perez Dr. Paul Vial Friday 8 1 Antibiotics Class: General highlights pharmacokinetic, pharmacodynamic and indications of major groups Dr. Carlos Perez 2 Upper respiratory infections: Tonsillopharyngitis, otitis, sinusitis. Dr.

Paul Vial Tuesday 12 *1 Infections of the central nervous system (CNS) Dr. Luis M. Noriega I: Meningitis clear liquid, purulent meningitis. *2 Seminar: lower respiratory infections: Dr. Luis M.

Noriega Classical and atypical bacterial pneumonia. Dr. Carlos Perez Dra. Patricia González Wednesday 13 1 bone and joint infections Dr. Guillermo Acuña 2

Sexually transmitted infections. Dr. Guillermo Acuña Thursday 14 1 Streptococcus and staphylococcus infections. Dr. Jorge Pérez 2 rash diseases and more frequent in the adult Vesicular: Measles, Rubella, Varicella. Dra. Marcela Ferres

Friday fifteen 1 CNS infections II: encephalitis, brain abscess. Dr. Carlos Perez 2 Seminar: Clinical cases on use of antibiotics Dr. Carlos Perez Dr. Jaime Labarca Monday

18 *1 Infections of skin and soft tissue Dr. Carlos Perez *2 Seminar: Intra-abdominal infections Dr. Carlos Perez Tuesday 19 1 Infections in immunosuppressed

Dr. Jaime Labarca 2 Seminar: Infections in immunosuppressed Dr. Jaime Labarca Dr. Carlos Perez Wednesday twenty 1 Fascioliasis, hydatidosis, trichinosis, cysticercosis, toxocariasis, toxoplasmosis: frequently in clinical practice Histoparasitosis. Dra.

Marisa Torres Thursday twenty-one 1 Evaluation Dr. Carlos Perez * Module Teaching Hospital Sotero del Rio UDA

Equine herpesvirus 1 and 4 – FAQ – horses, ponies and other animals

Equine herpesvirus infections (EHV-1 and EHV-4) The numbering tells it: in horses (and equine) has a number of distinct herpesviruses detected. They are numbered in the order of their discovery, and now we know 8 thereof, thereby coming EHV-1, -2, -3 and -4 in horses and EHV-5 prior to EHV-8 with donkeys. EHV-1 and EHV-4 are so dangerous that are available due to the importance of diseases induced by them vaccines. EHV-1 is the causative agent of the dreaded virus Aborts the horse: the apparently healthy mare verfohlt typically in the last third of gestation, dead or live weak foals are born. As the owner of a Wallaches one wonders of course, why you should be vaccinated against viral abortion. But much like EHV-4 solves EHV-1 and respiratory diseases from. Based on the symptoms, these two herpesviruses are indistinguishable – only Virusanzüchtung, detection of genetic or serum antibody increases after infection can clarify which virus is responsible for the febrile, acute cough in the barn. Sometimes mixed infections occur with both virus types. In particular, foals, yearlings and young adult horses suffer from the so-called rhinopneumonitis, where fortunately the infection usually is limited to the nose and throat and in conservation and good hygiene rarely leads to pneumonia. The herpes viruses hide in infected body cells, thus escape the defense and an apparently healthy horse again is therefore further support these viruses. A new outbreak typically occurs when the immune system of their host is affected by any stress. People who suffer from cold sores, this phenomenon know only too well.

but in horses occurs even without the human visible stressful situations more or less regularly to a proliferation of herpes viruses in the ubiquitous carrier animals. It do not always disease symptoms, as we know by repeated blood tests: antibody rises against these viruses are often detectable even in completely healthy appearing horses – the immune system has the virus multiplication. The more frequently the immune system deals with the herpesviruses, more harmless and ultimately improbable is an obvious disease – so it also explains that older horses ill rarely at rhinopneumonitis. But these older horses without symptoms can excrete the herpes viruses and infect other horses. Logically, then especially the younger vulnerable to obviously sick. But when the immune system is impaired by stress etc. , especially after long periods of transport, exhausting tournament use in its power, herpes viruses can cause an acute cough at any age. Infection occurs through droplets that fall into the mouth, nose or pharynx. While EHV-4 increased primarily in superficial cells of the respiratory tract and there though significant, but usually it triggers localized inflammation, penetrates EHV-1 regularly deeper into the body and is the bloodstream as placed in the uterus. But EHV-4 can even induce abortions – as so often in medicine, the differences in the symptoms are not absolute, but only probable. The logical conclusion: prevention of herpes-induced cough can only be successful if the vaccine defenses against both EHV-1 and EHV-4 mobilized. And here we are back to the intricate effect detection: tell antibody increases in serum really about protection against infection from taking place initially or even exclusively in the mucous membranes? We know that even after infection with EHV-1 antibody levels remain elevated in the blood only a few weeks and re-infection a few months after surviving the infection are again possible.

If even the infection and ownership triggers a poor immunity, how can you activate by given into the muscle vaccines locally occurring in the mucosal defense mechanisms? Just the primarily responsible for cell-mediated immunity can be so far but is difficult to measure. What is certain is that vaccinated horses excrete in case of infection shorter in time and in a smaller amount, the infectious herpesviruses. A longer lasting and greater effect of vaccination is by the use of live vaccines – achieved as opposed to inactivated vaccines. Their theoretical risks were pointed out in the previous article – the only licensed for horses in Germany live vaccine directed against EHV-1. Another way to make the vaccine more effective seems to exist in the mode of administration of the vaccine: no injection, but a spray in the nose is straight can stimulate local mucosal immunity. In the US, such “intranasal” have been approved vaccines against local Druse- and Influenza Virus recently. Unfortunately, it is still too early to really judge its practical value can. Back to EHV-1 and EHV-4: applies for the reasons mentioned above for herpesviruses therefore particularly pleased that even successful vaccination can not always completely prevent disease. Symptoms but at least mitigated and reduced viral shedding and thus retransmission. How often should one go vaccinate with such a widespread disease? The findings of antibody measurements in the blood has even been proposed to be pregnant mares from the 5th month immunize every 4 weeks with an inactivated EHV-1 vaccine to prevent abortions and the birth of infected foals. In practice, of course, is hardly feasible and medically, it seems very doubtful whether such a high Impffrequenz is really necessary.

Decisive this depends synonymous of the risk of infection from: the pregnant mare has ever contact with strangers, young and show horses, can bring the herpes viruses with in the barn? Is there unvaccinated horses near her, could secrete large amounts of virus? Den certainly very cautious thoroughbred breeders in the US are advised by officials now to have their pregnant mares vaccinated in the 5th, 7th and 9th month against EHV-1 routinely. Here I can only recommend growers to discuss the conditions in their stable with their veterinarian and set up an individual vaccination program. And what about the others? As explained above, it is particularly the young horses who suffer from herpes cough. Therefore, this should – after the usual primary vaccination – are at least semi-annually vaccinated against EHV-1 and EHV-fourth At high risk of infection, ie change of stable, a lot of contact with foreign horses, foreseeable conditions of stress, etc. , but it should be considered thoroughly in horses in the breeding and young competition horses, if you do not even inoculated every 3 to 4 months against herpes viruses. By contrast, never having strange animals coming into contact, senior leisure horse will perhaps be adequately protected with a vaccination every year. As you can see just the herpes vaccine requires time deviations from the scheme. You probably ask yourself slowly, why I have not been mentioned are also separated by herpesviruses (V. A. EHV-1, but in some cases probably also EHV-4) induced paralysis of the horse; because one on the protection before actually knows nothing.

Let me explain briefly: the herpes virus can settle even to incoordination (ataxia), lack of mobility and tail missing assets, urine and feces carry. It can come to the downer of the affected horses. Unfortunately, we know so far almost nothing about how the herpes viruses, the changes in the spinal cord that trigger the symptoms mentioned cause. Since this disease also (thankfully) does not occur very often, and is itself not regularly trigger by infection experiments, his research remains difficult. And about a possible vaccination against this form of herpes virus infection can, therefore, make no firm statements on time easy.

Virus infections in tortoises deaths tortoise pen – by Dr. Silvia Blahak

Virus infections in tortoises Deaths in tortoise pen Virus infections in tortoises have most serious consequences and often end losses. For over 20 years, they are now known. The three most important diseases are described in this article. Herpesvirus infection A herpes virus infection in a tortoise stock usually has disastrous consequences. Many tortoise species such as often held tortoise are highly susceptible and can not cope with the viral infection; often the entire stock will be extinguished. At risk are all tortoise species. In addition to European tortoises viruses have been detected even in such exotic African or Asian tortoises. Herpesviruses of tortoises are genetically clearly separate from herpesviruses turtles or mammals. A transfer to other animals or to humans is not possible. There are at least two laboratory-distinguishable strains, one occurs mainly in steppe tortoises ( “HorsfieldiiStamm”) and one at thighed tortoises ( “GraecaStamm”).

The GraecaStamm has a higher pathogenicity to the infected turtles; Here, the mortality rate is higher. The transfer between the turtles occurs through direct contact, not through the air. This means: with strict spatial separation and hygiene, a holder of both a group of healthy and infected animals maintain. Whether the virus is passed vertically over juveniles, is not yet clear; so far there is no evidence for it. symptoms Diseased animals covered by strong salivation, yellow, adhesive pads in the mouth, swelling of the throat area and occasionally conjunctivitis on. The turtles are apathetic and inappetent. More rarely occur diarrhea or central nervous system symptoms that may remain even after Survive a disease. In highly susceptible species may be fatal within days. Sonographic In an acute outbreak, the infection can best be ascertained through the section and virological examination of a dead animal. If that is not possible, a vengeance swab (not conserve in gel medium) be returned for PCRUntersuchung. Survivors turtles are latent herpes virus carriers because the virus is not eliminated, but withdraws into nerve cells.

Turtles, which survived the infection, usually behave completely normal and are not outwardly identify as herpes virus carriers. The turtles develop antibodies that keep the virus at bay. If the antibody threshold lowered (for example, by stress or other diseases), it may at any time, even after many years, can be reactivated. The animals show typical symptoms and shed the virus. Herpes virus carriers are therefore “living time bombs” in an inventory. Evidence can be surviving as infection by the antibodies; However, less than four to six weeks after infection. Therefore, the most important prevention measure is all the animals newly acquired (including inter alia Fund animals, nursing animals) to be tested for antibodies to herpes viruses, before they are put into inventory. My advice is a quarantine period of several months, the best on hibernation. In the period before and after hibernation, the turtles are particularly vulnerable, since sink antibody levels or only need to be rebuilt. Therefore, a blood test for herpes virus antibodies in the active period of the animals, so the period should be about four weeks to four weeks, performed before hibernation. Fig. 1: The coverings with a herpes viral infection fill the entire throat like in this Greek tortoise. Fig.


2: In the oral cavity this steppe turtle to find herpesvirus-typical coverings. Figure 3: Even exotic tortoises like this Radiated tortoise can die of a herpes viral infection. therapy Treatment consists primarily in support of the organism by infusion, force-feeding and antibiotics. Targeted therapy with the drug acyclovir is assessed differently. After each report a local (pharynx) or systemic treatment appears (for example, 80 mg / kg x 1 day) the animals to improve the prognosis, whereas other authors have reported no success. According to a recent study, the bioavailability of the agent is very poor in tortoises, so possibly a higher dosage must be used in order to achieve a sufficient blood levels. Studies on the development of a vaccine were not very successful, because the vaccinated turtles hardly showed seroconversion. They would also the problem that a serological differentiation between vaccinated and field virus-infected animals were no longer possible. After a herpes virus outbreak arises for many owners the question of whether and by what measures an outdoor enclosure can be reoccupied. After investigations on the stability of herpes viruses in the environment is clear that the inactivation of the studied herpesviruses is dependent on the outside temperature and UVWirkung of sunlight. At high temperatures in the summer the virus content is significantly reduced within three weeks, whereas the virus for months remains almost unchanged infectious at cooler temperatures in the spring. Therefore, a potentially infected tortoise pen should be at least a year to lie fallow in order to achieve a significant reduction in virus.

A complete disinfection can be achieved with the use of 20% strength milk of lime, digging and subsequent sowing. Ranavirusinfektion Far less occurs Ranavirusinfektion on a turtle stock. The virus comes from the family of iridoviruses that occur in various genera of insects, fish, reptiles and amphibians. Unlike the herpes virus infection here a transfer between different reptiles and amphibians is possible. Thus with Ranavirusisolaten tortoises already turtles such as RotwangenSchmuckschildkröten or terrapins such as Terrapins been infected. Also, a transmission between frogs and terrapins described. Within a tortoise group the virus through direct or indirect contact is spreading; here a transmission over the air does not seem to occur. The so far established in Germany outbreaks could all be traced back to imported animals. symptoms The symptoms are very similar to a herpes viral infection; a distinction is not possible on the basis of the clinical picture. The turtles have yellow pads in its mouth, show anorexia, apathy, and in this infection regularly conjunctivitis. The infection can have similar devastating consequences as a herpes virus infection, also dies a large part of the infected animals.

Diagnosis and prophylaxis The detection of the virus is carried by virological examination of a section or by animal revenge swab examination by PCR. In European tortoises also antibody of convalescence in a specific ELISA can be detected. Probably this virus does not go into a latent infection. The best prevention is a long as possible, preferably several months quarantine, including an examination for virus and / or antibodies as in the herpes virus infection. therapy There is no specific antiviral agent. The therapy can therefore only be supportive by infusions, force-feeding and antibiotics to prevent secondary bacterial infections. The virus is more stable than the herpes virus in the environment. After a Ranavirusinfektion in inventory an outdoor enclosure should therefore lie fallow or with 20% milk of lime to be treated before it is reoccupied at least one year. virus X This virus is known only for a few years and not yet confirmed its pathogenicity in infection experiments. It is a picornavirus, which must be based on the results classified in a new genus within the family.

symptoms According to clinical observations, a link between the sudden softening of the shell in pups and this viral infection appears to be. Since the armor can always have other causes (for example, feeding errors Hexamiteninfektion), these must first be excluded. In asymptomatic adult tortoises the virus can be found as an incidental finding. Diagnosis and prophylaxis At present the virus from moist throat swabs or organ material is grown on cell culture. After sequencing of parts of the genome also a PCR could be developed. Neutralizing antibodies can be detected in turtles. The extent to protect them from further infection is unclear. For prophylaxis juveniles should be mounted separately from the adult animals. Until now, treatment is no treatment known; infected animals die or are euthanized. Symptomatic treatment can be tried. take home

Virus infections are not rare in tortoises and lead to numerous deaths. The most important are herpesvirus, Ranavirus- and virus X Infection. From the herpes virus infection is known to be persistent infections with sign – toads leads, the animals appear clinically normal to survive the infection. Therefore, newcomers should always be placed in quarantine for several months and tested for antibodies to herpes viruses. Photo: © panthermedia | Ada Beka Pictures: Dr. Silvia Blahak

Fenistil Pencivir For Cold Sores – NetDoktor.de

When applied When cold sores Fenistil Pencivir? The drug is a drug whose active ingredient the growth of certain viruses inhibits (antiviral). Field of use: For relieving treatment of pain and itching, as well as to speed up the crust formation during natural healing process of acute episodes of mild forms of recurrent cold sores (recurrent herpes labialis). When should Fenistil Pencivir When cold sores not be used? A contraindication (lat. Contraindication) is a circumstance in which one can not apply a particular drug, as it can lead to dangerous, damage to health otherwise. The drug Fenistil Pencivir When cold sores should not be used, – If you previously by the application of acyclovir-containing creams a contact allergy has occurred already, or are known to react allergic to famciclovir or any of its ingredients. – On mucous membranes (. Eg in the mouth or genital area). You should especially be careful to prevent use in the eye or in the vicinity of the eye. – In immunosuppressed patients, therefore in patients whose body’s immune defenses is suppressed.

How to use For cold sores Fenistil Pencivir? Apply the medicine Fenistil Pencivir When cold sores always exactly as directed. You should check with your doctor or pharmacist if you are unsure. Unless otherwise prescribed by the doctor, this is the usual dose: Please contact the preparation possible directly on to the onset of symptoms (eg. As burning, itching). Nevertheless, should have already formed bubbles, you can still start using the drug, as well as a subsequent application accelerates the healing process and shortens the duration of pain. You should use the preparation while awake in 2-hour intervals (twice a day at least 6) Apply a thin coat on the infected skin. You should apply the cream after dinner. If you have already rubbed accidentally the cream one hour after application, you should carry out an additional application. Duration of treatment: You should continue the treatment with the preparation over a total of 4 days (corresponding to 96 hours). Please keep this time also, if you already feel better sooner.

Please do not discontinue treatment even if a substantial improvement is not immediately occurred. If during the Treatment comes with the drug in a deterioration of the skin appearance, you should discontinue treatment please and contact your doctor. Likewise, you should talk to your doctor if your cold sore is not healing properly after the treatment with the preparation. Overdose: If you apply more than you should, remove the excess cream with a cloth back from the skin. If you have a large amount of the drug have applied at once to the skin, so no more than slight skin irritation, no harmful effects are to be expected. If the preparation was once swallowed accidentally, except irritation in the area of ​​the oral mucosa may also be expected, no harmful effects. In both cases, no special treatment is necessary. If you still have concerns, please call your doctor or pharmacist. Forgotten application: If you forget one or two times to apply your medicine at the correct time, take it as soon as you possibly can (longer breaks may influence the effect). The next application should then be carried out every 2 hours.

To apply on skin. Apply a thin layer on the infected skin with a clean finger. Alternatively, you can also use a cotton swab that has been coated with an amount necessary for the size of the skin area affected. If you should apply the cream with the fingers, wash before please and thoroughly after applying the cream hands. What side effects may occur? From a side effect is when in addition to the intended effect of the drug other undesirable effects. Like all medicines, also have this side effects, although not everybody gets them. In evaluating side effects Frequencies are defined as: Very common: more than 1 user in 10 Common: affects 1 to 10 of 100 Uncommon: affects 1 to 10 of 1000 Rare: 1 to 10 users in 10,000 Very rare: less than 1 in 10,000

Not known: frequency can not be estimated from the available data Occasionally it may experience reactions at the treated skin sections (z. B. transient burning, stinging, numbness). Are the side effects very strong, so you stop the treatment and tell your doctor or pharmacist. Isolated cases of hypersensitivity reactions such. As contact dermatitis, rash, hives, itching and edema that are limited both to the application site and occurred in addition, have been reported. If you notice any undesirable effects with you, please inform your doctor or pharmacist, so he notice the severity and possibly decide on further action required or can advise. Please tell your doctor or pharmacist if any of you side effects gets serious, or you notice any side effects not listed. What must be observed when using other drugs? If you take Fenistil Pencivir When cold sores with other medicines, there may be interactions. Read here what you need to consider: Please inform your doctor or pharmacist if you are taking other medicines / or have recently taken / used, even if it is not prescribed.

For the medicine Fenistil Pencivir For Cold Sores There are no indications of interactions with other drugs. What else you need to know Driving and using machines: There are no known effects. Children: In patients under 12 years still is no experience on the use of this product. For this reason, the preparation in these patients should not be used. More special precautions are required while using the drug. If you are not sure whether you suffer from cold sores (herpes labialis), ask your doctor for advice. Store drug out of reach of children. What should be considered in pregnancy Please tell your doctor and ask him for advice, if you are pregnant or breast-feeding, since the drug Fenistil Pencivir When cold sores during pregnancy and lactation should be applied only after careful benefit-risk assessment. Ask.

Before taking / using any medicine your doctor or pharmacist for advice