McLaughlin Milena M, Sutton Sarah H, Jensen Ashley O, Esterly John S
Northwestern Memorial Hospital, Chicago, IL, USA.
Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, USA.
Infect Dis Ther. 2017 Jun;6(2):259-264. doi: 10.1007/s40121-017-0157-y. Epub 2017 Apr 17.
In late 2011, a shortage of IV acyclovir led to the need to empirically substitute high-dose oral valacyclovir (HDVA) to conserve IV acyclovir for patients with confirmed herpes simplex virus (HSV) meningitis or encephalitis. This report describes the management of the most recent national IV acyclovir shortage by the Antimicrobial Stewardship Program (ASP) at Northwestern Memorial Hospital (NMH), Chicago, IL, USA, and the use of HDVA. Secondarily, we assessed the safety and tolerability of HDVA as an alternate to IV acyclovir during this shortage.
We report the step-wise management, restrictions, and guidelines implemented at NMH during a protracted IV acyclovir shortage. The assessment of HDVA was a retrospective, observational cohort study of hospitalized patients receiving HDVA between 1 January 2012 and 31 December 2013. Appropriate demographic and treatment variables were collected. The primary outcome was percentage of patients experiencing an adverse event.
There were 15 adult patients included in the study on a median daily dose of HDVA of 3 g (IQR 2-8). There were four patients with microbiologically confirmed viral CNS infections (n = 1 HSV-1, n = 2 HSV-2, n = 1 VZV encephalitis) and eleven patients with unknown causative pathogens. Six (40%) patients experienced at least one adverse drug reaction (ADR) to HDVA (thrombocytopenia, 33.3%, n = 5; headache, 6.7%, n = 1; nausea, 6.7%, n = 1; rash, 6.7%, n = 1). One patient (6.7%) was readmitted within 30 days with a suspected non-CNS infection. There were no treatment discontinuations or symptomatic therapy necessary to treat any of the ADRs.
The shortage of IV acyclovir was successfully managed by the ASP and HDVA appeared to be well tolerated when used as an alternative to IV acyclovir.
2011年末，静脉注射用阿昔洛韦短缺，因此有必要经验性地改用高剂量口服伐昔洛韦（HDVA），以便为确诊为单纯疱疹病毒（HSV）脑膜炎或脑炎的患者保留静脉注射用阿昔洛韦。本报告描述了美国伊利诺伊州芝加哥西北纪念医院（NMH）抗菌药物管理项目（ASP）对最近全国性静脉注射用阿昔洛韦短缺的应对措施以及HDVA的使用情况。其次，我们评估了在短缺期间HDVA作为静脉注射用阿昔洛韦替代品的安全性和耐受性。
我们报告了在静脉注射用阿昔洛韦长期短缺期间NMH实施的逐步管理、限制措施和指南。对HDVA的评估是一项回顾性观察队列研究，研究对象为2012年1月1日至2013年12月31日期间接受HDVA治疗的住院患者。收集了适当的人口统计学和治疗变量。主要结局是发生不良事件的患者百分比。
该研究纳入了15名成年患者，HDVA的每日中位剂量为3克（四分位间距2 - 8）。有4名患者经微生物学确诊为病毒性中枢神经系统感染（1例HSV - 1，2例HSV - 2，1例水痘带状疱疹病毒脑炎），11名患者的致病病原体不明。6名（40%）患者对HDVA至少发生了1次药物不良反应（ADR）（血小板减少，33.3%，n = 5；头痛，6.7%，n = 1；恶心，6.7%，n = 1；皮疹，6.7%，n = 1）。1名患者（6.7%）在30天内因疑似非中枢神经系统感染再次入院。治疗过程中没有因任何ADR而停药或进行对症治疗。
ASP成功应对了静脉注射用阿昔洛韦的短缺问题，并且HDVA作为静脉注射用阿昔洛韦的替代品似乎耐受性良好。
