Evidence
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Efficacy
High-dose versus low-dose for HSV treatment:
An open-label evaluation of IV aciclovir prospectively compared 16 patients receiving 45 mg/kg/day and 72 patients receiving 60 mg/kg/day in divided doses to historical controls from a previously reported trial which used 30 mg/kg/day. Survival rate for the high-dose aciclovir was found to be significantly greater than for low-dose aciclovir. Recipients of high-dose aciclovir also had a borderline significant decrease in morbidity. Neutropenia, renal dysfunction, abnormal platelet count, low haemoglobin and elevated AST were noted but the possible adverse drug reactions of high-dose aciclovir couldn’t be separated from the effects of viral infection and underlying medical conditions. 20 mg/kg/dose 8 hourly aciclovir is also recommended by American Academy of Pediatrics (AAP) and Australasian Society for Infectious Diseases (ASID).1,2,6 (LOE III-3, GOR C)
HSV suppression following treatment to prevent CNS sequelae:
Neonates were enrolled in two parallel, identical, double-blind, placebo-controlled studies. Neonates with central nervous system (CNS) involvement were enrolled in one study, and neonates with skin, eye, and mouth involvement only were enrolled in the other. After completing a regimen of 14 to 21 days of parenteral aciclovir, the infants were randomly assigned to immediate aciclovir suppression (300 mg per square meter of body-surface area per dose orally, three times daily for 6 months) or placebo. The Mental Development Index of the Bayley Scales of Infant Development was assessed at 12 months of age in 28 of 45 infants enrolled with HSV CNS involvement. After adjustment for covariates, infants assigned to aciclovir suppression had significantly higher mean scores than infants assigned to placebo. There was a trend toward more neutropenia in the aciclovir group (1,5) (LOE II, GOR B).
VZV (Varicella zoster virus) treatment:
20 mg/kg/dose 8 hourly is recommended by ASID guidelines but is not supported by data from any trial.
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