Watson W A, Rhodes N J, Echenique I A, Angarone M P, Scheetz M H
Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, USA.
Department of Pharmacy Practice, Midwestern University, Chicago College of Pharmacy, Downers Grove, FL, USA.
J Clin Pharm Ther. 2017 Jun;42(3):350-355. doi: 10.1111/jcpt.12520. Epub 2017 Mar 29.
Neurotoxicity is a side effect of acyclovir. We report the first case, to our knowledge, whereby Bayesian-informed clearance estimates supported a therapeutic intervention for acyclovir-associated neurotoxicity.
A 62-year-old male with the diagnosis of disseminated zoster was being treated with intravenous (IV) acyclovir when he developed symptoms of acute neurotoxicity. Acyclovir had been dose-adjusted for renal dysfunction according to traditional creatinine clearance estimates; however, as the patient was also on vancomycin, Bayesian estimates of vancomycin clearances were performed, which revealed a 2-fold lower creatinine clearance. In response to the Bayesian estimates, acyclovir was discontinued, and improvements in mentation were noted within 24 hours.
Alternate approaches to estimate renal function beyond Cockcroft-Gault, such as a Bayesian approach used in our patient, should be considered when population estimates are likely to be inaccurate and potentially dangerous to the patient.
神经毒性是阿昔洛韦的一种副作用。据我们所知，我们报告了首例通过贝叶斯法估算清除率来支持对阿昔洛韦相关性神经毒性进行治疗干预的病例。
一名62岁诊断为播散性带状疱疹的男性患者在接受静脉注射阿昔洛韦治疗时出现急性神经毒性症状。根据传统的肌酐清除率估算值对阿昔洛韦剂量进行了肾功能不全调整；然而，由于患者同时还使用万古霉素，因此对万古霉素清除率进行了贝叶斯估算，结果显示肌酐清除率低了两倍。根据贝叶斯估算结果，停用了阿昔洛韦，患者在24小时内精神状态有所改善。
当群体估算可能不准确且对患者有潜在危险时，应考虑采用除Cockcroft - Gault公式之外的其他估算肾功能的方法，比如我们患者所使用的贝叶斯方法。
