Background

Acyclovir is widely used to treat children with Herpes Simplex Virus(HSV) and Varicella Zoster Virus(VZV) infections. For HSV/VZV meningoencephalitis, the US Food Drug Administration recommends IV acyclovir 20mg/kg/dose(high-dose) 8 hourly for children ≥3 months old whereas American Academy of Paediatrics recommends 15mg/kg/dose 8 hourly for children 3 months to 12 years old due to reports of nephrotoxicity, especially in those ≥12 years old with concomitant ceftriaxone. 

We sought to determine the incidence of AKI in those receiving high-dose IV acyclovir for meningoencephalitis in our institution, KKH.

Methods

This is a retrospective cohort study of children ≤18 years old admitted to KKH from 1st March 2016 to 31st March 2017 and received at least one dose of high-dose IV acyclovir for meningoencephalitis. We excluded those with pre-existing kidney disease. AKI was defined as an estimated Glomerular Filtration Rate decrease of ≥25% from baseline(paediatric RIFLE criteria).

Results

Of the 214 children on IV acyclovir, 45 had other indications and 30 received low-dose acyclovir for meningoencephalitis; hence, 139 children were included(mean age: 5.28±4.8 years). The median duration of IV acyclovir was 2 days[interquartile range:2-3 days] and all patients were adequately hydrated. Only 18 patients had repeated serum creatinine during treatment and within a week of acyclovir discontinuation. Two patients aged 12 and 15 years old, developed AKI after an average of 3.5 days from initiation, and both had concomitant ceftriaxone. 

Conclusion

Our incidence of AKI secondary to high-dose IV acyclovir for paediatric meningoencephalitis was 1.4%, lower than 13.1% reported in two studies, where the median onset of AKI was 1-14 days. High-dose IV acyclovir could be considered for treatment of HSV/VZV meningoencephalitis in ≤12 years old, but hydration and close monitoring of renal function would be prudent.

11 / HIGH-DOSE INTRAVENOUS(IV) ACYCLOVIR FOR PAEDIATRIC MENINGOENCEPHALITIS – AN INCREASED RISK OF ACUTE KIDNEY INJURY(AKI)?