Administration of oral acyclovir suppressive therapy after neonatal herpes simplex virus disease limited to the skin, eyes and mouth: Results of a phase I/II trial

David Kimberlin, Dwight Powell, William Gruber, Pamela Diaz, Ann Arvin, Mary Kumar, Richard Jacobs, Russell Van Dyke, Sandra Burchett, Seng Jaw Soong, Alfred Lakeman, Richard Whitley, C. Laughlin, R. Whitley, A. Lakeman, S. J. Soong, D. Kimberlin, S. Stagno, R. Pass, A. ArvinC. Prober, J. Bradley, S. Spector, L. Corey, G. Demmler, S. Burchett, S. Adler, J. Bale, Y. Bryson, T. Chonmaitree, P. Diaz, J. Gross, W. Gruber, R. Jacobs, H. Keyserling, J. Kinney, A. Kovacs, M. Kumar, S. Laudert, C. Leach, E. Leistikow, R. McKinney, C. Meissner, J. Modlin, D. Powell, M. Rathore, P. Reuman, J. Robinson, W. Vaudry, C. Sander, M. Shelton, M. De Sierra, L. Stanberry, S. Starr, R. Steele, G. Storch, R. Van Dyke, L. Weiner

    Research output: Contribution to journalArticle

    130 Scopus citations

    Abstract

    Background. Neonatal herpes simplex virus (HSV) infections limited to the skin, eyes and mouth (SEM) can result in neurologic impairment. A direct correlation exists between the development of neurologic deficits and the frequency of cutaneous HSV recurrences. Thus, the National Institutes of Allergy and Infectious Diseases Collaborative Antiviral Study Group conducted a Phase I/II trial of oral acyclovir therapy for the suppression of cutaneous recurrences after SEM disease in 26 neonates. Methods. Infants ≤1 month of age with virologically confirmed HSV-2 SEM disease were eligible for enrollment. Suppressive oral acyclovir therapy (300 mg/m 2/dose given either twice daily or three times per day) was administered for 6 months. Results. Twelve (46%) of the 26 infants developed neutropenia (<1000 cells/mm 3) while receiving acyclovir. Thirteen (81%) of the 16 infants who received drug 3 times per day experienced no recurrences of skin lesions while receiving therapy. In comparison, a previous Collaborative Antiviral Study Group study found that only 54% of infants have no cutaneous recurrences in the 6 months after resolution of neonatal HSV disease if oral acyclovir suppressive therapy is not initiated. In one infant, HSV DNA was detected in the cerebrospinal fluid during a cutaneous recurrence, and an acyclovir-resistant HSV mutant was isolated from another patient during the course of the study. Conclusions. Administration of oral acyclovir can prevent cutaneous recurrences of HSV after neonatal SEM disease. The effect of such therapy on neurologic outcome must be assessed in a larger, Phase III study. As such, additional investigation is necessary before routine use of suppressive therapy in this population can be recommended.

    Original languageEnglish (US)
    Pages (from-to)247-254
    Number of pages8
    JournalPediatric Infectious Disease Journal
    Volume15
    Issue number3
    DOIs
    StatePublished - Apr 11 1996

    Keywords

    • Newborn
    • acyclovir
    • herpes simplex
    • prophylaxis

    ASJC Scopus subject areas

    • Pediatrics, Perinatology, and Child Health
    • Microbiology (medical)
    • Infectious Diseases

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    Kimberlin, D., Powell, D., Gruber, W., Diaz, P., Arvin, A., Kumar, M., Jacobs, R., Van Dyke, R., Burchett, S., Soong, S. J., Lakeman, A., Whitley, R., Laughlin, C., Whitley, R., Lakeman, A., Soong, S. J., Kimberlin, D., Stagno, S., Pass, R., ... Weiner, L. (1996). Administration of oral acyclovir suppressive therapy after neonatal herpes simplex virus disease limited to the skin, eyes and mouth: Results of a phase I/II trial. Pediatric Infectious Disease Journal, 15(3), 247-254. https://doi.org/10.1097/00006454-199603000-00014