SEQUENTIAL USE OF INTRAVENOUS AND ORAL ACYCLOVIR IN THE THERAPY OF VARICELLA IN IMMUNOCOMPROMISED CHILDREN

Background. Immunocompromised children are at risk for disseminated va ricella infections. Standard management involves hospitalization and i ntravenous acyclovir for 7 to 10 days. This approach is expensive, is inconvenient and may not be necessary. We undertook a pilot study to a ssess the safety and efficacy of an alternative approach that utilized a combination of intravenous (iv) followed by oral (po) acyclovir in a cohort of immunocompromised children. Methods, The cohort consisted of 26 immunocompromised children between the ages of 1.5 and 12.7 year s (mean, 6,3). Therapy was commenced with iv acyclovir (1500 mg/m(2)/d ay in 3 divided doses). Concurrent management included holding or redu cing immunosuppressive therapy (by 50%) and administering varicella-zo ster immunoglobulin in 69% (11 of 16) of cases where exposure to chick enpox was recognized. Patients were eligible to switch to po therapy a fter receiving a minimum of 48 h of iv acyclovir therapy provided they were afebrile; had no new lesions for 24 h; had no internal organ inv olvement and were able to tolerate oral medications. Patients were obs erved in hospital for a further 24 h and then discharged provided they remained well. Oral acyclovir was continued for a total of 7 to 10 da ys (iv plus po). Results. Of the 26 patients 25 were successfully swit ched from iv to po after 4.1 +/- 1.2 days (mean +/- SD) (range, 2.3 to 6) Children had fever for a mean of 2.0 +/- 1.6 days(range, 0 to 5) a nd developed new lesions for 2.9 +/- 0.7 days (range, 2 to 4), All 25 patients switched to po therapy had resolution of their disease and no patient required resumption of iv therapy, Conclusions. The sequentia l use of iv followed by po acyclovir is feasible in the treatment of v aricella in immunocompromised children and results in a reduction in d uration of intravenous therapy and hospitalization.