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.
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.
Authors: R J Whitley; C A Alford; M S Hirsch; R T Schooley; J P Luby; F Y Aoki; D Hanley; A J Nahmias; S J Soong Journal: N Engl J Med Date: 1986-01-16 Impact factor: 91.245
Authors: D W Kimberlin; C Y Lin; R F Jacobs; D A Powell; L Corey; W C Gruber; M Rathore; J S Bradley; P S Diaz; M Kumar; A M Arvin; K Gutierrez; M Shelton; L B Weiner; J W Sleasman; T M de Sierra; S Weller; S J Soong; J Kiell; F D Lakeman; R J Whitley Journal: Pediatrics Date: 2001-08 Impact factor: 7.124
Authors: B Sköldenberg; M Forsgren; K Alestig; T Bergström; L Burman; E Dahlqvist; A Forkman; A Frydén; K Lövgren; K Norlin Journal: Lancet Date: 1984-09-29 Impact factor: 79.321
Authors: Jessica E Ericson; Martyn Gostelow; Julie Autmizguine; Christoph P Hornik; Reese H Clark; Daniel K Benjamin; P Brian Smith Journal: Pediatr Infect Dis J Date: 2017-04 Impact factor: 3.806