Berkhout, Angela

Clark, Julia E

Jones, Cheryl A

Grimwood, Keith

McMullan, Brendan

Britton, Philip N

Palasanthiran, Pamela

Lim, Selina

Yeoh, Daniel K

Wong, Shirley

Cheng, Daryl R

Gwee, Amanda

Cross, Jack

Nguyen, Tran

Jeffs, Emma

Walls, Tony

Mahony, Michelle

Yan, Jennifer

Nourse, Clare

2024-11-18

Variations in neonatal aciclovir prescribing for suspected herpes simplex virus (HSV) disease are well-known, but there are limited data describing aciclovir prescribing in older children.Medical records of neonates (≤28 days) and children (29 days to 18 years) prescribed intravenous aciclovir for suspected HSV disease (1 January 2019-12 December 2019) in eight Australian and New Zealand hospitals were reviewed. Prescribing indication, HSV testing, aciclovir prescription details, adverse events and discharge diagnosis were recorded.1426 received empirical aciclovir. For neonates (n = 425), the median duration was 1 day (IQR 1-3), 411/425 underwent HSV investigations and 13/425 had HSV disease (two with disseminated encephalitis, four with encephalitis and seven with skin, eye, mouth disease). Of the 1001 children, 906 were immunocompetent. 136/906 suspected of mucocutaneous disease received aciclovir for a median of 2 days (1-2), 121/136 underwent HSV testing, and 69/136 had proven disease. 770/906 received aciclovir for suspected disseminated disease or encephalitis for a median of 1 day (1-2), 556/770 underwent HSV testing, and 5/770 had disseminated disease or encephalitis. Among 95 immunocompromised children, 53/58 with suspected mucocutaneous disease had HSV testing and this was confirmed in 22. Disseminated disease or encephalitis was suspected in 37/95, HSV testing conducted in 23/37 and detected in one. The median aciclovir duration was 3 (2-7) days for immunocompromised children. Nephrotoxicity occurred in 7/1426 and 24/1426 had an extravasation injury.Frequent and often unnecessary intravenous aciclovir prescribing for suspected HSV encephalitis or disseminated disease occurred in children, as evidenced by incomplete HSV investigations and only 5/770 older children having the diagnosis confirmed.

Infection Management and Prevention Service, The Queensland Children's Hospital, Brisbane, Queensland 4101, Australia.

Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.

The Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network (SCHN), Sydney, New South Wales, Australia.

Departments of Paediatrics and Infectious Diseases, Gold Coast Health, Southport, Queensland, Australia.

Antimicrobials Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.

Infection Management and Prevention Service, The Queensland Children's Hospital, Brisbane, Queensland 4101, Australia.

Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.

The Australian Paediatric Surveillance Unit, Kids Research, Sydney Children's Hospitals Network (SCHN), Sydney, New South Wales, Australia.

Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.

Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead (SCHN), Sydney, New South Wales, Australia.

Departments of Paediatrics and Infectious Diseases, Gold Coast Health, Southport, Queensland, Australia.

School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia.

National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.

Department of Infectious Diseases, Sydney Children's Hospital, Randwick, New South Wales, Australia.

School of Clinical Medicine, Discipline of Paediatrics, University of New South Wales, Sydney, New South Wales, Australia.

Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead (SCHN), Sydney, New South Wales, Australia.

School of Clinical Medicine, Discipline of Paediatrics, University of New South Wales, Sydney, New South Wales, Australia.

Department of Infectious Diseases, Sydney Children's Hospital, Randwick, New South Wales, Australia.

School of Clinical Medicine, Discipline of Paediatrics, University of New South Wales, Sydney, New South Wales, Australia.

The Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.

National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.

The Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.

Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.

Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead (SCHN), Sydney, New South Wales, Australia.

Antimicrobials Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.

Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.

Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.

Antimicrobials Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.

Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.

Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.

Departments of Paediatrics and Infectious Diseases, Gold Coast Health, Southport, Queensland, Australia.

Department of Infectious Diseases, Sydney Children's Hospital, Randwick, New South Wales, Australia.

Department of Paediatrics, University of Otago, Christchurch, New Zealand.

Department of Paediatrics, University of Otago, Christchurch, New Zealand.

Research for Children Aotearoa, Department of Paediatrics, University of Otago, Christchurch, New Zealand.

Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.

Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia.

Department of Paediatrics, Royal Darwin Hospital, Darwin, Northern Territory, Australia.

Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.

Infection Management and Prevention Service, The Queensland Children's Hospital, Brisbane, Queensland 4101, Australia.

Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.

J Antimicrob Chemother . 2024 Nov 18:dkae411. doi: 10.1093/jac/dkae411. Online ahead of print.

1460-2091

0000-0001-6173-7768

0000-0002-6284-612X

https://pubmed.ncbi.nlm.nih.gov/39556200/?otool=iaurydwlib

https://hdl.handle.net/10137/13821

Parenteral aciclovir for suspected herpes simplex virus infection in children: 0-18 years.

Journal Article

Publication