Aciclovir use in infants and children (0-18 years) – how appropriate is parenteral use for suspected or proven HSV infections?

Duration: 2019 – 2025

Funding Source: HDR Scholarship, UQ

Chief Investigators: Angela Berkhaut, Cheryl Jones, Julia Clark, Phil Britton, Vishal Kapoor, Clare Nourse

PhD Student: Angela Berkhaut

Aim

The purpose of this study is to describe the current prescribing practices of parenteral aciclovir in tertiary paediatric hospitals in Australia and New Zealand. The appropriateness of aciclovir therapy with respect to the drug dose and duration will be compared to local (hospital) and national guidelines. Time to aciclovir prescription, clinical features at time of prescription, investigations performed and concordance to local (hospital), and national guidelines will be described. Confirmed neonatal HSV or HSV encephalitis cases will be further evaluated and described.

Background

The non-specific presentation of HSV infection and high risk of adverse outcomes following encephalitis or neonatal disease have driven increasing empiric prescription of aciclovir in neonates and children in America, Canada and elsewhere. Clinician threshold for commencement of parenteral aciclovir varies widely despite availability of published guidelines for both conditions.

Key Clinical Challenges Include:

• Potential consequences of increasing empiric aciclovir use include increased cost of care, increased length of hospital stay, complication of intravenous access (including extravasation injury), drug adverse effects and the development of antiviral resistance.

• There have been no contemporary published studies that have evaluated prescribing practices of aciclovir in Australia or New Zealand.
• There is a need to understand prescribing practices, to further define high-risk age groups and particular clinical features of neonatal HSV infection and HSV encephalitis to guide aciclovir use, limit unnecessary treatment and evaluate implementation of national guidelines for these conditions. 

Impact

Results will be disseminated to emergency medicine, general paediatrics, infectious diseases and critical care teams to provide education and refine guidelines.