Parenteral aciclovir for suspected herpes simplex virus infection in children: 0-18 years
- 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;
- Journal Title
- Journal of Antimicrobial Chemotherapy
- Publication Type
- Online publication before print
- 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.
- Department(s)
- Infectious Diseases
- Publisher's Version
- https://doi.org/10.1093/jac/dkae411
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Creation Date: 2024-12-10 02:43:09
Last Modified: 2024-12-10 02:54:14