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Acyclovir dosing in herpes encephalitis: A scoping review.

Asma Aboelezz, Sherif Hanafy Mahmoud

Journal of the American Pharmacists Association : Japha

|February 16, 2024

Summary

Determining the correct acyclovir dose for obese patients with herpes encephalitis is challenging. This review highlights the need for further research to establish optimal dosing strategies and prevent adverse effects or ineffective treatment.

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Area of Science:

* Neurology
* Infectious Diseases
* Pharmacology

Background:

* Herpes encephalitis is a severe viral infection treated solely with acyclovir.
* Current acyclovir dosing guidelines (10 mg/kg/dose IV every 8 hours) lack clarity for obese patients.
* Incorrect dosing in obese individuals may lead to subtherapeutic levels or toxicity (nephrotoxicity/neurotoxicity).

Purpose of the Study:

* To conduct a scoping review of existing evidence on acyclovir dosing in obese patients with herpes encephalitis.

Main Methods:

* Comprehensive database search (MEDLINE, EMBASE, Scopus, Web of Science, CINAHL) conducted on May 26, 2023.
* Screening and selection of articles performed by two independent reviewers using Covidence software.
* Inclusion of 22 articles in the review.

Main Results:

* Acyclovir-associated nephrotoxicity prevalence ranged from 13% to 21%; neurotoxicity data was undefined.
* Evidence is lacking on outcomes associated with subtherapeutic acyclovir concentrations.
* Suggested approach: use adjusted body weight for obese patients with normal kidney function; consider maximum doses for those with augmented renal clearance.

Conclusions:

* Significant inconsistency exists regarding the appropriate body weight for calculating acyclovir dosage in obese patients.
* Further studies are recommended to compare acyclovir concentrations in obese versus non-obese patients.
* Future research should correlate acyclovir concentrations with patient outcomes to refine dosing guidelines.