Kvi. Rolston et al., AMBULATORY MANAGEMENT OF VARICELLA-ZOSTER VIRUS-INFECTION IN IMMUNOCOMPROMISED CANCER-PATIENTS, Supportive care in cancer, 6(1), 1998, pp. 57-62
Citations number
21
Categorie Soggetti
Oncology,Rehabilitation,"Health Care Sciences & Services
Immunocompromised patients with varicella-zoster virus (VZV) infection
are at greater risk for dissemination and the development of complica
tions than immunocompetent individuals. Consequently, they are general
ly hospitalized in strict isolation rooms and treated with parenterall
y administered acyclovir. Although effective, this approach is expensi
ve and creates logistic difficulties in the hospital. We treated 38 im
munosuppressed cancer patients presenting to our ambulatory treatment
center with VZV infections with intravenous acyclovir (500 mg/m(2) 8-h
ourly) in an ambulatory/home setting. Patients were monitored for succ
ess or failure of therapy, progression of infection, development of co
mplications or drug toxicity, and satisfaction/compliance with therapy
. Most patients (33, or 87%) responded to therapy. Among the failures,
2 patients had progressive VZV infection, 2 were hospitalized due to
renal toxicity, and 1 developed a superinfection, All patients eventua
lly responded and there were no deaths on this study. Two patients rel
apsed within 1 month of initial response. Both responded to retreatmen
t with acyclovir, without hospitalization. The median duration of pare
nteral therapy with acyclovir was 7.5 days. Seven patients (18%) had t
o be switched to oral acyclovir (800 mg, 5 times a day) before complet
e response, owing to problems with venous access. All 7 completed ther
apy successfully. Overall, patients expressed a high level of satisfac
tion with outpatient therapy, and there were no instances of noncompli
ance or patient requests for withdrawal from study. The results of thi
s study indicate that VZV infections in clinically stable immunosuppre
ssed cancer patients are relatively benign and do not require hospital
ization. Parenterally administered acyclovir in an ambulatory setting
is effective therapy for such infections.