Viral infections are one of the major complications after bone marrow transplantation, with high mortality and morbidity. Fourty-six patients between 3 and 48 years old (median 15 years) received orally 400 mg (under age 6, 200 mg) acyclovir 4 times daily from day −12 before to day 84 after BMT. All patients were isolated in laminar-airflow units for at least 23 days with total enteral decontamination. They were concomitantly treated with anti-CMV-hyperimmunoglobulin and cotrimoxazol. During acyclovir prophylaxis seven patients had herpes simplex virus infections, all of them were seropositive before BMT.
Acyclovir plasma concentrations were measured by use of a new HPLC method.
No acyclovir was present (detection limit 40 ng/ml) in the plasma of five out of six patients with HSV infections. Three of them had non-compliance, and a lack of acyclovir absorption developed in two patients under conditioning regimen.
No drug-related side effects were observed. Laboratory tests did not show liver or renal toxicity. Take and hematologic reconstitution were unchanged.
In our study, oral acyclovir reduced the incidence of herpes simplex infections after bone marrow transplantation. Herpes infections only occurred in patients with non-compliance or lack of acyclovir absorption.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
bone marrow transplantation
Burns WH, Santos GW, Saral R, Laskin OL, Lietman PS, McLaren C, Barry DW (1982) Isolation and characterization of resistant herpes simplex virus after acyclovir therapy. Lancet I:421–433
Crumpacker CS, Schnipper LE, Marlowe SI, Kowalsky PN, Hershey BJ, Levin MJ (1982) Resistance to antiviral drugs of herpes simplex virus isolated from a patient treated with acyclovir. N Engl J Med 306:343–346
Dekker C, Ellis MN, McLaren C, Hunter G, Rogers J, Barry DW (1983) Virus resistance in clinical practice. J Antimicrob Chemother 12 (Suppl B):137–152
Field HJ (1983) A perspective on resistance to acyclovir in herpes simplex virus. J Antimicrob Chemother 12 (Suppl B):129–135
Gluckman E, Lotsberg J, Devergie A, Zhao XM, Melo R, Gomez-Morales M, Mazeron MC, Perol Y (1983) Oral acyclovir prophylactic treatment of herpes simplex infection after bone marrow transplantation. J Antimicrob Chemother 12 (suppl B):161–167
Hann IM, Prentice HG, Blacklock HA, Ross MGR, Brigden D, Rosling AE, Burke C, Crawford DH, Brumfitt W, Hoffbrand AV (1983) Acyclovir prophylaxis against herpes virus infections in severely immunocompromised patients. Br Med J 287:384–388
Land G, Bye A (1981) Simple high-performance liquid chromatographic method for the analysis of 9-(2-hydroxyethoxymethyl)guanine (acyclovir) in human plasma and urine. J Chromatogr 224:51–58
Meyers JD, Flournoy N, Thomas ED (1980) Infection with herpes simplex virus and cell-mediated immunity after marrow transplant. J Infect Dis 142:338–346
Ostendorf P, Ehninger G, Schmidt H, Haen M, Link H, Schüch K, Müller CA, Wernet P, Dopfer R, Klingebiel T, Niethammer D, Frommhold W, Hübener KH, Breitling G, Schneider W, Waller HD (1986) Knochenmarktransplantation bei chronisch myeloischer Leukämie. Dtsch Med Wochenschr (im Druck)
Prentice HG (1983) Use of acyclovir for prophylaxis of herpes infections in severly immunocompromised patients. J Antimicrob Chemother 12 (suppl B):153–159
Ramsey PG, Fife KH, Hackman RC, Meyers JD, Corey L (1982) Herpes simplex virus pneumonia: clinical, virologic, and pathologic features in 20 patients. Ann Intern Med 97:813–820
Saral R, Burns WH, Laskin OL, Santos GW, Lietman PS (1981) Acyclovir prophylaxis of herpes-simplex virus infections. N Engl J Med 305:63–67
Saral R, Ambinder RF, Burns WH, Angelopulos CM, Griffin DE, Burke PJ, Lietman PS (1983) Acyclovir prophylaxis against herpes simplex virus infection in patients with leukemia. Ann Intern Med 99:773–776
Schaeffer HJ, Beauchamp L, De Miranda P, Elion GB, Bauer DJ, Collins P (1978) 9-(2-hydroxyethoxymethyl)guanine activity against viruses of the herpes group. Nature 272:583–585
Seale L, Jones CJ, Kathpalia S, Jackson GG, Mozes M, Maddux MS, Packham D (1985) Prevention of herpesvirus infection in renal allograft recipients by low-dose oral acyclovir. JAMA 254:3435–3438
Shepp DH, Newton B, Dandliker (1984) Oral acyclovir therapy of mucocutaneous herpes simplex virus infection in immunocompromised patients. ICAAC, Washington, DC, Abstract 1249
Wade JC, Newton B, McLaren C, Flournoy N, Keeney RE, Meyers JD (1982) Intravenous acyclovir to treat mucocutaneous herpes simplex virus infection after marrow transplantation. Ann Intern Med 96:265–269
Wade JC, McLaren C, Meyers JD (1983) Frequency and significance of acyclovir-resistant herpes simplex virus isolated from marrow transplant patients receiving multiple courses of treatment with acyclovir. J Infect Dis 148:1077–1082
Wade JC, Day LM, Crowley A (1984) Recurrent infection with herpes simplex virus after bone marrow transplantation: role of the specific immune response and acyclovir treatment. J Infect Dis 149:750–756
Wade JC, Newton B, Flournoy N, Meyers JD (1984) Oral acyclovir for prevention of herpes simplex virus reactivation after marrow transplantation. Ann Intern Med 100:823–828
Herrn Prof. Dr. H.D. Waller zum 60. Geburtstag gewidmet
About this article
Cite this article
Ehninger, G., Vallbracht, A., Schüch, K. et al. Orale Prophylaxe von Herpes-Infektionen mit Acyclovir nach Knochenmarktransplantation: Eine klinische und klinisch-pharmakologische Untersuchung. Klin Wochenschr 64, 570–574 (1986). https://doi.org/10.1007/BF01735321
- Acyclovir, bioavailability
- Drug monitoring
- Bone marrow transplantation
- Herpes infections, prevention and control