Doxycycline in Oral Herpes Simplex

[mhb08112]

Hello Pharmacists,

I have a quick question for you.

In the BNF, under the indications for Doxycycline - it lists Oral HSV.

As HSV is a virus, and not a bacterial infection, I was wondering how Doxycycline helped in the treatment of it?

I do have something in the back of my mind saying that Oral herpes simplex can lead to a secondary bacterial infection which would therefore require antibiotics - however I can not remember where I have read that - and therefore have no source.

I was just wondering if anybody would be able to clarify for me the usefulness of doxycycline in this case - or even direct me to a place where I can do my own further reading (I know some of the students that post on this site give the rest of us a bad name). I have tried using the BNF however I feel that I'm going round in circles.

Thanks.

[mhb08112]

I'm not a lazy no good student - this is not an assignment - it is just out of curiosity! I promise!

[PHARMAC1ST]

This is a very good question of which i don't really know the answer to. I would assume it would be for secondary bacterial infections/ lesions but not 100% on this one. I'm curious too for the answer

[bobbin]

In the BNF, under the indications for Doxycycline - it lists Oral HSV.

As HSV is a virus, and not a bacterial infection, I was wondering how Doxycycline helped in the treatment of it?

In the treament of ulceration of the oral mucosa, topical doxycycline is used because it is believed to prevent the breakdown of tissues - not because of its antimicrobial effects. For the same reason, doxycycline (as Periostat) is effective for chronic periodontal disease.

According to the medical journal Acta Odontol Scand. 2009 Feb;67(1):25-9............

OBJECTIVE: Aphthous ulceration is a common form of recurrent ulceration of the oral mucosa. Numerous treatments have been tried as a means of relieving pain, disinfecting the ulcer base, and reducing inflammation, but with limited success. Tetracycline and its derivatives have been shown to be inhibitors of matrix metalloproteinases (MMPs), which are part of the inflammatory response and contribute to the breakdown of tissue in the ulcer. Of the commercially available tetracyclines, doxycycline has shown the best inhibition of the MMPs. The aim of this study was to test clinically whether the inhibitory effect of a low-dose doxycycline in a hydrogel on MMPs would speed the recovery of oral ulceration.

MATERIAL AND METHODS: Forty-nine patients participated in a randomized, double-blind, placebo-controlled trial.

RESULTS: Sixty-eight percent of ulcers had healed by the third day of treatment with the doxycycline gel, whereas only 25% of the patients receiving the placebo reported healing of their ulcers within 3 days. Patients treated with the docycline gel recounted faster reduction in pain during the treatment period than the placebo group did.

CONCLUSIONS: Incorporation of low-dose doxycycline in a muco-adhesive gel has been demonstrated to have potential in the treatment of recurrent oral ulceration. It is concluded that MMP enzymes can be inhibited by low doses of doxycycline below levels likely to disrupt the oral flora.

Bobbin

[mhb08112]

Thank you Bobbin!

[bobbin]

Thank you Bobbin!

You are most welcome.

The tetracyclines are an interesting group of drugs. Minocycline, in particular, is known to affect the immune system. It exerts an anti-inflammatory and disease-modulating effect in rheumatoid arthritis.....and probably numerous other conditions too.

[Teethlai]

You are most welcome.

The tetracyclines are an interesting group of drugs. Minocycline, in particular, is known to affect the immune system. It exerts an anti-inflammatory and disease-modulating effect in rheumatoid arthritis.....and probably numerous other conditions too.

I thought minocycline was only used for acne lol

[DavidS]

I thought minocycline was only used for acne lol

Bobbin's posts are always worth chasing up on "search" if you are short of a bit of useful CPD.