W A Watson1, N J Rhodes1,2, I A Echenique3, M P Angarone4, M H Scheetz1,2. 1. Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, USA. 2. Department of Pharmacy Practice, Midwestern University, Chicago College of Pharmacy, Downers Grove, FL, USA. 3. Department of Infectious Disease, Cleveland Clinic Florida, Weston, FL, USA. 4. Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Abstract
WHAT IS KNOWN AND OBJECTIVE: Neurotoxicity is a side effect of acyclovir. We report the first case, to our knowledge, whereby Bayesian-informed clearance estimates supported a therapeutic intervention for acyclovir-associated neurotoxicity. CASE SUMMARY: A 62-year-old male with the diagnosis of disseminated zoster was being treated with intravenous (IV) acyclovir when he developed symptoms of acute neurotoxicity. Acyclovir had been dose-adjusted for renal dysfunction according to traditional creatinine clearance estimates; however, as the patient was also on vancomycin, Bayesian estimates of vancomycin clearances were performed, which revealed a 2-fold lower creatinine clearance. In response to the Bayesian estimates, acyclovir was discontinued, and improvements in mentation were noted within 24 hours. WHAT IS NEW AND CONCLUSION: Alternate approaches to estimate renal function beyond Cockcroft-Gault, such as a Bayesian approach used in our patient, should be considered when population estimates are likely to be inaccurate and potentially dangerous to the patient.
WHAT IS KNOWN AND OBJECTIVE:Neurotoxicity is a side effect of acyclovir. We report the first case, to our knowledge, whereby Bayesian-informed clearance estimates supported a therapeutic intervention for acyclovir-associated neurotoxicity. CASE SUMMARY: A 62-year-old male with the diagnosis of disseminated zoster was being treated with intravenous (IV) acyclovir when he developed symptoms of acute neurotoxicity. Acyclovir had been dose-adjusted for renal dysfunction according to traditional creatinine clearance estimates; however, as the patient was also on vancomycin, Bayesian estimates of vancomycin clearances were performed, which revealed a 2-fold lower creatinine clearance. In response to the Bayesian estimates, acyclovir was discontinued, and improvements in mentation were noted within 24 hours. WHAT IS NEW AND CONCLUSION: Alternate approaches to estimate renal function beyond Cockcroft-Gault, such as a Bayesian approach used in our patient, should be considered when population estimates are likely to be inaccurate and potentially dangerous to the patient.
Authors: O L Laskin; J A Longstreth; R Saral; P de Miranda; R Keeney; P S Lietman Journal: Antimicrob Agents Chemother Date: 1982-03 Impact factor: 5.191
Authors: James P Smith; Stephen Weller; Benjamin Johnson; Janet Nicotera; James M Luther; David W Haas Journal: Antimicrob Agents Chemother Date: 2009-12-28 Impact factor: 5.191