Is aciclovir prophylaxis necessary after bone marrow transplantation?

To assess the cost-effect relationship of aciclovir prophylaxis versus early treatment, we performed a retrospective study in 44 allogeneic bone marrow transplant recipients, who had only received aciclovir for therapeutic purposes. After bone marrow transplantation 18 herpes simplex infections occurred in 15 of the 33 patients who were seropositive for herpes simplex virus. In ten patients without clinical signs, routine viral cultures yielded herpes simplex virus. Aciclovir was given intravenously to the patients with mucocutaneous herpes infection. All infections responded rapidly. It can be calculated that restricting the drug to therapeutic use reduced the amount of aciclovir used, which in turn diminished the cost of treatment and the risk of aciclovir resistance.