Advertisement

Pediatric Drugs

, Volume 16, Issue 3, pp 229–234 | Cite as

Standard-Dose Versus High-Dose Acyclovir in Children Treated Empirically for Encephalitis: A Retrospective Cohort Study of Its Use and Safety

  • Jennifer G. KendrickEmail author
  • Mary H. H. Ensom
  • Andrew Steer
  • Colin T. White
  • Eddie Kwan
  • Roxane R. Carr
Original Research Article

Abstract

Background

Intravenous acyclovir is the treatment of choice for herpes simplex virus encephalitis. In 2006, the American Academy of Pediatrics updated its dosing recommendations for children aged 3 months to 12 years to receive high-dose acyclovir (60 mg/kg/day). The association between acyclovir dose and toxicity is unclear.

Objective

The purpose of our study was to review our institution’s experience with standard- and high-dose acyclovir for the empiric treatment of encephalitis.

Study Design, Setting and Patients

This retrospective cohort study included patients aged 1 month to 18 years who received acyclovir as empiric treatment for encephalitis between 2005 and 2009 at a tertiary care children’s hospital. We excluded patients with baseline renal impairment and those without serum creatinine measurements prior to and during treatment.

Main Outcome Measure

The main outcome measure of this study was to compare the occurrence of renal injury or failure between children who received the standard- versus high-dose regimen.

Results

Sixty-one patients were included (n = 32 standard-dose; n = 29 high-dose). There was no statistical difference in change in serum creatinine from baseline between children who received standard- versus high-dose acyclovir (0 vs. 5.1 %; p = 0.79). One child in the standard-dose group and three children in the high-dose group developed renal injury or failure during treatment (3.1 vs. 10.3 %; p = 0.34). Children with renal injury or failure were older, had a longer length of stay, and longer duration of therapy than children without.

Conclusions

The incidence of renal injury or failure was similar between children who received standard-dose and high-dose acyclovir.

Keywords

Herpes Simplex Virus Encephalitis Acyclovir Renal Injury Herpes Simplex Virus Encephalitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

The authors declare no relevant conflicts of interest. No sources of funding were used for the preparation of this manuscript.

References

  1. 1.
    Whitley RJ, Alford CA, Hirsch MS, et al. Vidarabine versus acyclovir therapy in herpes simplex encephalitis. New Engl J Med. 1986;314:144–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Skoldenberg B, Forsgren M, Alestig K, et al. Acyclovir versus vidarabine in herpes simplex encephalitis. Randomised multicentre study in consecutive Swedish patients. Lancet. 1984;2:707–11.PubMedCrossRefGoogle Scholar
  3. 3.
    Whitley RJ, Kimberlin DW. Herpes simplex encephalitis: children and adolescents. Semin Pediatr Infect Dis. 2005;16:17–23.PubMedCrossRefGoogle Scholar
  4. 4.
    Pickering LK, editor. Red Book: report of the committee of infectious diseases. 29th ed. American Academy of Pediatrics; 2012.Google Scholar
  5. 5.
    Kimberlin DW, Lin C-Y, Jacobs RF, et al. Safety and efficacy of high-dose intravenous acyclovir in the management of neonatal herpes simplex virus infections. Pediatrics. 2001;108:230–8.PubMedCrossRefGoogle Scholar
  6. 6.
    McMillian JA, editor. Red Book: report of the committee of infectious diseases. 27th ed. American Academy of Pediatrics; 2006.Google Scholar
  7. 7.
    Kneen R, Jakka S, Mithyantha R, et al. The management of infants and children treated with aciclovir for suspected viral encephalitis. Arch Dis Child. 2010;95:100–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Schwartz GJ, Haycock GB, Edelmann CM Jr, et al. A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics. 1976;58:259–63.PubMedGoogle Scholar
  9. 9.
    Schwartz GJ, Brion LP, Spitzer A. The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am. 1987;34:571–90.PubMedGoogle Scholar
  10. 10.
    Akcan-Arikan A, Zappitelli M, Loftis LL, et al. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007;71:1028–35.PubMedCrossRefGoogle Scholar
  11. 11.
    Bellomo R, Ronco C, Kellum JA, et al. Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8:R204–12.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Vomiero G, Carpenter B, Robb I, et al. Combination of ceftriaxone and acyclovir—an underestimated nephrotoxic potential? Pediatr Nephrol. 2002;17:633–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Schreiber R, Wolpin J, Koren G. Determinants of acyclovir-induced nephrotoxicity in children. Pediatr Drugs. 2008;10:135–9.CrossRefGoogle Scholar
  14. 14.
    Meadows JT, Shook L, Ballard HO, et al. Acyclovir use in sick infants. Pediatr Emerg Care. 2010;26:495–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Kimura H, Aso K, Kuzushima K, et al. Relapse of herpes simplex encephalitis in children. Pediatrics. 1992;89:891–4.PubMedGoogle Scholar
  16. 16.
    Ito Y, Kimura H, Yabuta Y, et al. Exacerbation of herpes simplex encephalitis after successful treatment with acyclovir. Clin Infect Dis. 2000;30:185–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Jennifer G. Kendrick
    • 7
    Email author
  • Mary H. H. Ensom
    • 1
    • 2
  • Andrew Steer
    • 3
    • 4
  • Colin T. White
    • 5
    • 6
  • Eddie Kwan
    • 1
  • Roxane R. Carr
    • 1
    • 2
  1. 1.Pharmacy DepartmentChildren’s and Women’s Health Centre of British ColumbiaVancouverCanada
  2. 2.Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverCanada
  3. 3.Royal Children’s HospitalMelbourneAustralia
  4. 4.University of MelbourneMelbourneAustralia
  5. 5.Division of Nephrology, Department of PediatricsBC Children’s HospitalVancouverCanada
  6. 6.Faculty of MedicineUniversity of British ColumbiaVancouverCanada
  7. 7.Pharmacy DepartmentChildren’s and Women’s Health Centre of BCVancouverCanada

Personalised recommendations