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Persistent Gaps in Appropriate Use of Empiric Acyclovir in Neonates

Peyton Wilson1, Ashley G Sutton1, Christopher Nassef1

  • 11 University of North Carolina at Chapel Hill, NC, USA.

Clinical Pediatrics
|December 13, 2016
PubMed

Insights

Pediatricians face uncertainty when deciding on empiric acyclovir for suspected neonatal herpes simplex virus (HSV) infections. This study highlights the need for improved diagnostic evaluation in high-risk infants to optimize treatment and reduce unnecessary medication.

Area of Science:

  • Neonatal infectious diseases
  • Pediatric pharmacology
  • Clinical decision-making

Background:

  • Empiric acyclovir use for suspected neonatal herpes simplex virus (HSV) infection is common but debated.
  • Clinical uncertainty exists regarding the initiation and diagnostic workup for neonatal HSV.

Purpose of the Study:

  • To identify gaps in the decision-making process for initiating empiric acyclovir in neonates.
  • To assess current pediatric practices for evaluating possible HSV infection.

Main Methods:

  • Retrospective chart review of infants receiving empiric acyclovir.
  • Survey administered to pediatricians on current HSV evaluation practices.

Main Results:

  • Of 70 infants receiving empiric acyclovir, only 4.3% tested positive for HSV.
  • 13 of 14 high-risk infants had incomplete diagnostic testing.
  • Survey revealed significant uncertainty in acyclovir initiation and diagnostic test composition.

Conclusions:

  • Clinical uncertainty persists in the empiric acyclovir decision for neonatal HSV.
  • Future quality improvement projects should focus on reducing empiric use in low-risk infants and ensuring complete testing in high-risk infants.

Keywords:
acyclovirfebrile infantherpes simplex virus (HSV)neonate

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