Parenteral aciclovir for suspected herpes simplex virus infection in children: 0-18 years

Berkhout, A; Clark, JE; Jones, CA; Grimwood, K; McMullan, B; Britton, PN; Palasanthiran, P; Lim, S; Yeoh, DK; Wong, S; Cheng, DR; Gwee, A; Cross, J; Nguyen, T; Jeffs, E; Walls, T; Mahony, M; Yan, J; Nourse, C

Author(s): Berkhout, A; Clark, JE; Jones, CA; Grimwood, K; McMullan, B; Britton, PN; Palasanthiran, P; Lim, S; Yeoh, DK; Wong, S; Cheng, DR; Gwee, A; Cross, J; Nguyen, T; Jeffs, E; Walls, T; Mahony, M; Yan, J; Nourse, C;
Details: Publication Year 2025-02-03,Volume 80,Issue #2,Page 354-362
Journal Title: Journal of Antimicrobial Chemotherapy
Publication Type: Research article
Abstract: BACKGROUND: Variations in neonatal aciclovir prescribing for suspected herpes simplex virus (HSV) disease are well-known, but there are limited data describing aciclovir prescribing in older children. METHODS: Medical records of neonates (≤28 days) and children (29 days to 18 years) prescribed intravenous aciclovir for suspected HSV disease (1 January 2019-12 December 2019) in eight Australian and New Zealand hospitals were reviewed. Prescribing indication, HSV testing, aciclovir prescription details, adverse events and discharge diagnosis were recorded. RESULTS: 1426 received empirical aciclovir. For neonates (n = 425), the median duration was 1 day (IQR 1-3), 411/425 underwent HSV investigations and 13/425 had HSV disease (two with disseminated encephalitis, four with encephalitis and seven with skin, eye, mouth disease). Of the 1001 children, 906 were immunocompetent. 136/906 suspected of mucocutaneous disease received aciclovir for a median of 2 days (1-2), 121/136 underwent HSV testing, and 69/136 had proven disease. 770/906 received aciclovir for suspected disseminated disease or encephalitis for a median of 1 day (1-2), 556/770 underwent HSV testing, and 5/770 had disseminated disease or encephalitis. Among 95 immunocompromised children, 53/58 with suspected mucocutaneous disease had HSV testing and this was confirmed in 22. Disseminated disease or encephalitis was suspected in 37/95, HSV testing conducted in 23/37 and detected in one. The median aciclovir duration was 3 (2-7) days for immunocompromised children. Nephrotoxicity occurred in 7/1426 and 24/1426 had an extravasation injury. CONCLUSION: Frequent and often unnecessary intravenous aciclovir prescribing for suspected HSV encephalitis or disseminated disease occurred in children, as evidenced by incomplete HSV investigations and only 5/770 older children having the diagnosis confirmed.
Publisher: Oxford University Press
Keywords: Humans; *Acyclovir/administration & dosage/therapeutic use/adverse effects; *Antiviral Agents/administration & dosage/therapeutic use; Child; Infant; *Herpes Simplex/drug therapy/diagnosis; Adolescent; Infant, Newborn; Female; Male; Child, Preschool; New Zealand; Australia; Simplexvirus/drug effects; Retrospective Studies; Administration, Intravenous
Department(s): Infectious Diseases
Publisher's Version: https://doi.org/10.1093/jac/dkae411
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-12-10 02:43:09

Last Modified: 2025-02-04 07:05:21