Rudd C, Rivadeneira E D, Gutman L T
Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
Acta Paediatr. 1994 Dec;83(12):1237-43. doi: 10.1111/j.1651-2227.1994.tb13004.x.
Herpes simplex virus lesions recur in 8-30% of infants who receive a course of parenteral antiviral therapy for an initial infection. Long-term acyclovir is used by some clinicians to prevent recurrent Herpes simplex disease. We describe nine infants who were treated with doses of oral acyclovir which were chosen to achieve 2-h post-plasma concentrations of > or = 2 micrograms/ml. Eight infants had Herpes simplex encephalitis and one had multiple recurrences of dermal and ocular disease. The target plasma concentration was chosen in order to attain acyclovir cerebrospinal fluid distribution (< or = 50% plasma) for an estimated ID30 of Herpes simplex II strains of 0.1-0.5 microgram/ml. One of nine patients failed to achieve the target plasma acyclovir concentration. One of nine patients developed symptomatic recurrence of the central nervous system disease and none of the remaining eight patients experienced recognized dermal or neurologic recurrence of Herpes simplex disease. Renal and neurologic status were routinely monitored and no signs of acyclovir toxicity were observed. Plasma concentration of acyclovir > or = 2 micrograms/ml may be achieved with average oral doses of 1340 mg/m2/dose (1000-1740 mg/m2/dose) given at 12-h intervals.
接受初始感染的肠胃外抗病毒治疗疗程的婴儿中，8%至30%会出现单纯疱疹病毒损伤复发。一些临床医生使用长期阿昔洛韦来预防单纯疱疹疾病复发。我们描述了9名婴儿，他们接受的口服阿昔洛韦剂量能使血浆浓度在服药后2小时达到≥2微克/毫升。8名婴儿患有单纯疱疹性脑炎，1名婴儿患有皮肤和眼部疾病的多次复发。选择目标血浆浓度是为了使阿昔洛韦在脑脊液中的分布（≤血浆的50%）达到单纯疱疹病毒II型菌株估计ID30为0.1至0.5微克/毫升。9名患者中有1名未达到目标血浆阿昔洛韦浓度。9名患者中有1名出现中枢神经系统疾病的症状性复发，其余8名患者均未出现单纯疱疹疾病公认的皮肤或神经复发。对肾脏和神经状况进行了常规监测，未观察到阿昔洛韦毒性迹象。每12小时间隔给予平均口服剂量1340毫克/平方米/剂量（1000 - 1740毫克/平方米/剂量），可使阿昔洛韦血浆浓度≥2微克/毫升。
