Efficacy of acyclovir for herpes simplex encephalitis

Wang, Wei; Ji, Meng

doi:10.1097/md.0000000000015254

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…HSV children had less frequently fever (although not statistically significant, P = 0.05), developed more frequently seizures (P = 0.02) and had higher risk of PICU admission (P = 0.04), confirming a more severe clinical scenario in case of HSV children and the need of including anti-HSV treatments particularly for more severe cases. 1,28,29 Our study has limitations to address. The retrospective nature is an intrinsic limitation that may have led to missing information.…”

Section: Discussionmentioning

confidence: 98%

Diagnosis and Therapy of Infectious Encephalitis in Children: A Ten-Years Retrospective Study

Pata

Buonsenso

Frasca

et al. 2021

Pediatric Infectious Disease Journal

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Background: Infectious encephalitis represents a rare but potentially severe clinical condition. However, limited international data are available in pediatric age. Methods: We conducted a retrospective study to review (a) the clinical presentation; (b) laboratory, radiology, and neurophysiology findings; (c) the correlations between these exams and outcome; and (d) the therapy performed.Results: Fifty-six patients were enrolled [22 female (39.6%), mean age 4.7 years, IQR 0.7-8.7 years], 19.6% presented neurologic sequelae. HSV was the single most frequently isolated pathogen (19.6%), although in most cases, the etiology remained undefined. 41.1% children presented prodromal before the development of neurologic signs. Fever was the most frequent constitutional symptom (83.9% of cases). Cerebrospinal fluid was normal in 48.5% of cases and electroencephalograpy in 24.5% cases. Brain computed tomography scans was normal in 33 (91.7%) cases, while cerebral magnetic resonance imaging (MRI) showed pathologic findings in 62.5% of cases. MRI was the only parameter associated with neurologic sequalae [P = 0.01; OR, 8.1 (95% CI: 1.52-42.84)]. Conclusions: Pediatric encephalitis is a heterogeneous entity with nonspecific clinical and laboratory findings, with undefined etiologies in most times. MRI can play a primary role, both on a diagnostic and prognostic point-ofview, and its role should be implemented and made more accessible. Further studies are needed to define the exact role and timing of steroids.

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Section: Discussionmentioning

confidence: 98%

Diagnosis and Therapy of Infectious Encephalitis in Children: A Ten-Years Retrospective Study

Pata

Buonsenso

Frasca

et al. 2021

Pediatric Infectious Disease Journal

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“…Acyclovir is widely used to treat HSE and supposedly reduces mortality, but robust evidence on its precise effect is lacking, particularly when the diagnosis is uncertain (26). The pattern of acyclovir treatment in this study is in concurrence with previous reports and reflects the existing uncertainty in empirical acyclovir practices.…”

Section: Discussionmentioning

confidence: 99%

“…Outside the neonatal period, renal dysfunction may be minimized by dosing IV acyclovir below the threshold associated with nephrotoxicity (i.e., ≤ 500 mg/m 2 /dose or ≤ 15 mg/kg/dose), particularly in older patients (24,25). Acyclovir is widely used to treat HSE and supposedly reduces mortality, but robust evidence on its precise effect is lacking, particularly when the diagnosis is uncertain (26). The pattern of acyclovir treatment in this study is in concurrence with previous reports and reflects the existing uncertainty in empirical acyclovir practices.…”

mentioning

confidence: 99%

An Observational Study on Pattern of Empirical Acyclovir Therapy in Children With Acute Encephalitis From Northern India

Adarsha

Samprathi

Sankhyan

et al. 2023

Pediatric Critical Care Medicine

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Objectives: To identify the prevalence of herpes simplex encephalitis (HSE), factors influencing the duration of empirical acyclovir and frequency of acute kidney injury (AKI) in children with acute encephalitis syndrome (AES). Design: Prospective observational study. Setting: Pediatric Emergency Department and PICU of a tertiary hospital in Northern India. Patients: All consecutive, eligible children between 1 month and 12 years old presenting with AES, defined as altered consciousness for greater than 24 hours (including lethargy, irritability, or a change in personality) and two or more of the following signs: 1) fever (temperature ≥ 38°C) during the current illness, 2) seizures or focal neurological signs, 3) cerebrospinal fluid (CSF) pleocytosis, 4) electroencephalogram, and/or 5) neuroimaging suggesting encephalitis, who received at least one dose of acyclovir. Interventions: None. Measurements and Main Results: Of the 101 children screened, 83 were enrolled. The median (interquartile range [IQR]) age was 3 years (1–6 yr). Thirty-one children (37.3%) were diagnosed with AES, of which four were labeled as probable HSE (three based on MRI brain, one based on serology). Scrub typhus, dengue, Japanese encephalitis, and mumps were the other infective causes. The median (IQR) duration of acyclovir therapy was 72 hours (24–264 hr); 21 children (25.3%) received acyclovir for less than 24 hours and 11 (13.3%) for greater than or equal to 14 days. New-onset AKI was seen in 18 children (21.7%) but was mostly transient. Death (n = 8, 9.6%) and discontinuation of care due to futility or other reasons (n = 15, 18%) were noted in 23 children (28%). Factors associated with duration of acyclovir greater than 7 days, on univariable analysis, were lower modified Glasgow Coma Score at admission, requirement of invasive ventilation, invasive intracranial pressure monitoring, and CSF pleocytosis (5–500 cells). On multivariable analysis, only CSF pleocytosis of 5–500 cells was associated with duration of acyclovir greater than 7 days. Conclusions: Given the low prevalence of HSE, and the risk of AKI, this study sensitizes the need to review our practice on initiation and stopping of empirical acyclovir in children with acute encephalitis.

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Acyclovir Brain Disposition: Interactions with P-gp, Bcrp, Mrp2, and Oat3 at the Blood–Brain Barrier

Shan

Cen

Zhang

et al. 2022

Eur J Drug Metab Pharmacokinet

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Efficacy of acyclovir for herpes simplex encephalitis

Cited by 4 publications

References 17 publications

Diagnosis and Therapy of Infectious Encephalitis in Children: A Ten-Years Retrospective Study

Diagnosis and Therapy of Infectious Encephalitis in Children: A Ten-Years Retrospective Study

An Observational Study on Pattern of Empirical Acyclovir Therapy in Children With Acute Encephalitis From Northern India

Acyclovir Brain Disposition: Interactions with P-gp, Bcrp, Mrp2, and Oat3 at the Blood–Brain Barrier

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