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Incidence, patterns, risk factors and clinical outcomes of intravenous acyclovir induced nephrotoxicity

Abdullah M Al-Alawi1,2, Juhaina Salim Al-Maqbali3, Maria Al-Adawi2

  • 1Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman.

Saudi Pharmaceutical Journal : SPJ : the Official Publication of the Saudi Pharmaceutical Society
|July 11, 2022
PubMed
Abstract

Insights

Acyclovir-induced nephrotoxicity occurred in 20.1% of patients. Advanced age, longer treatment duration, and vancomycin use increased risk. Kidney function monitoring and IV hydration are crucial for prevention.

Area of Science:

  • Pharmacology
  • Nephrology
  • Infectious Diseases

Background:

  • Acyclovir is a key antiviral medication for herpes simplex virus (HSV) and varicella-zoster virus.
  • Renal excretion of acyclovir can lead to drug crystal accumulation and potential nephrotoxicity.
  • Understanding acyclovir-induced nephrotoxicity is critical for patient safety.

Purpose of the Study:

  • To determine the incidence of acyclovir-induced nephrotoxicity.
  • To identify significant risk factors associated with its development.
  • To outline preventive measures and clinical outcomes.

Main Methods:

  • Retrospective cohort study design.
  • Inclusion of patients over 12 years old receiving intravenous (IV) acyclovir.
  • Data collected from January 2016 to December 2020 at Sultan Qaboos University Hospital.

Main Results:

  • Acyclovir-induced nephrotoxicity was observed in 40 out of 191 patients (20.1%).
  • Independent risk factors included older age, longer duration of IV acyclovir treatment, and concurrent vancomycin administration.
  • Mortality was 4.5%, with 1.5% requiring renal replacement therapy.

Conclusions:

  • Close monitoring of renal function is essential for patients receiving IV acyclovir, particularly older individuals and those on vancomycin.
  • Intravenous hydration is a key preventive strategy.
  • Antimicrobial stewardship programs can help minimize treatment duration, thereby reducing nephrotoxicity risk.
Keywords:
AcyclovirEncephalitisMeningitisacyclovir induced-nephrotoxicity

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