Details

Autor(en) / Beteiligte

• Mendiratta, Anil
• Peacock, James E

Titel

EMPIRIC THERAPY WITH ACYCLOVIR IN PATIENTS WITH PRESUMED VIRAL ENCEPHALITIS: CLINICAL AND ECONOMIC IMPLICATIONS

Ist Teil von

• Infectious diseases in clinical practice (Baltimore, Md.), 2002-02, Vol.11 (2), p.58-65

Ort / Verlag

Lippincott Williams & Wilkins, Inc

Erscheinungsjahr

2002

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• The use of empiric acyclovir (ACV) in patients with the clinical syndrome of encephalitis appears to be common. Accordingly, we examined the clinical and economic implications of empiric ACV use in 45 patients with presumed viral encephalitis. Of these 45 patients, a definitive diagnosis was established in only 6 (13%), 5 of whom had herpes simplex virus encephalitis (HSVE). Seventy-six percent (34/45) of patients received empiric ACV, 22 of whom (65%) completed at least a 10-day course of parenteral therapy. Of the 34 patients receiving empiric ACV, 8 (24%) had neither clinical or neurodiagnostic findings suggestive of HSVE on presentation. Five of those 8 patients (15% of those treated empirically and 11% of total patients) received a complete course of IV ACV despite having no evidence suggestive of HSVE (i.e., inappropriate therapy per study definitions). The “unnecessary drug costs” associated with the treatment of those 5 patients for a minimum of 10d were $10,820.50. In patients with suspected viral encephalitis, the empiric use of ACV is common, even in the absence of focal findings on presentation. A complete course of ACV (> 10d) is often provided despite failure to confirm the diagnosis of HSVE. The potential consequences of “inappropriate use” of ACV are possible increased drug resistance, unnecessary toxicity (especially nephrotoxicity), and excessive medical costs (> $2,000 for each “inappropriate” treatment course). To minimize the adverse clinical and economic impact of “inappropriate” empiric usage of ACV, clearcut guidelines for treatment and ready access to polymerase chain reaction (PCR) testing need to be established.