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Standard-dose versus high-dose acyclovir in children treated empirically for encephalitis: a retrospective cohort

Jennifer G Kendrick1, Mary H H Ensom, Andrew Steer

  • 1Pharmacy Department, Children's and Women's Health Centre of BC, Room 0B9 4480, Oak St, Vancouver, BC, V6H 3V4, Canada, Jennifer.Kendrick@cw.bc.ca.

Paediatric Drugs
|February 6, 2014
PubMed

Insights

High-dose acyclovir (60 mg/kg/day) for pediatric encephalitis showed similar renal toxicity compared to standard-dose. This study found no significant difference in kidney injury rates between the two treatment regimens in children.

Area of Science:

  • Pediatric Neurology
  • Infectious Diseases
  • Pharmacology

Background:

  • Intravenous acyclovir is the standard treatment for herpes simplex virus encephalitis.
  • Updated 2006 American Academy of Pediatrics guidelines recommend high-dose acyclovir (60 mg/kg/day) for children aged 3 months to 12 years.
  • The relationship between acyclovir dosage and potential toxicity, particularly renal effects, remains unclear in pediatric patients.

Purpose of the Study:

  • To evaluate the safety and efficacy of standard- versus high-dose acyclovir in pediatric patients.
  • To compare the incidence of renal injury or failure between children receiving standard-dose and high-dose acyclovir regimens.
  • To analyze institutional experience with empiric acyclovir treatment for encephalitis in a pediatric population.

Main Methods:

  • Retrospective cohort study including 61 patients (1 month to 18 years) treated between 2005-2009.
  • Patients received either standard-dose or high-dose acyclovir for empiric encephalitis treatment.
  • Exclusion criteria included baseline renal impairment and lack of serum creatinine measurements before and during treatment.

Main Results:

  • No statistically significant difference in the change in serum creatinine from baseline between standard-dose and high-dose groups (0% vs. 5.1%, p=0.79).
  • The incidence of renal injury or failure was similar between groups (3.1% standard-dose vs. 10.3% high-dose, p=0.34).
  • Children who developed renal injury/failure were older, had longer hospital stays, and longer treatment durations.

Conclusions:

  • The incidence of renal injury or failure was comparable between children treated with standard-dose and high-dose acyclovir.
  • High-dose acyclovir, as recommended by recent guidelines, does not appear to increase the risk of renal toxicity in pediatric patients with encephalitis.
  • Further research may be warranted to explore other potential toxicities or long-term effects associated with different acyclovir dosing regimens.
Abstract

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