There is no direct evidence that aciclovir has a beneficial effect on outcomes in Ramsay Hunt syndrome (herpes zoster oticus, HZO, associated with acute facial paralysis), although the use of aciclovir in patients with HZ in other parts of the body suggest that they have a role also in HZO.
A Cochrane review 1 included 1 low-quality study with a total of 15 subjects. All participants received intravenous corticosteroids (methylprednisolone 20 mg/8 hours for 10 days). Seven participants only received this treatment (control group) whilst eight (the treatment group) received in addition intravenous acyclovir (10 mg/kg/8h for 10 days). No statistically significant difference between the two groups was found.
Comment: The quality of evidence is downgraded by imprecise results (very few patients and wide confidence intervals) and by study quality (lack of blinding).
1. Uscategui T, Dorée C, Chamberlain IJ, Burton MJ. Antiviral therapy for Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults. Cochrane Database Syst Rev 2008 Oct 8;(4):CD006851. [PMID:18843734]
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"Aciclovir for Ramsay Hunt Syndrome." Evidence-Based Medicine Guidelines, Duodecim Medical Publications Limited, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/EBMG/455861/all/Aciclovir_for_Ramsay_Hunt_syndrome.
Aciclovir for Ramsay Hunt syndrome. Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. https://evidence.unboundmedicine.com/evidence/view/EBMG/455861/all/Aciclovir_for_Ramsay_Hunt_syndrome. Accessed January 22, 2021.
Aciclovir for Ramsay Hunt syndrome. (2019). In Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited. Retrieved January 22, 2021, from https://evidence.unboundmedicine.com/evidence/view/EBMG/455861/all/Aciclovir_for_Ramsay_Hunt_syndrome
Aciclovir for Ramsay Hunt Syndrome [Internet]. In: Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. [cited 2021 January 22]. Available from: https://evidence.unboundmedicine.com/evidence/view/EBMG/455861/all/Aciclovir_for_Ramsay_Hunt_syndrome.
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