Thursday, August 14, 2014

Do Older Febrile Infants Also Require Empiric Acyclovir?

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by US Dept. of Agriculture via Flickr
More and more often, we are seeing acyclovir added to the antibiotic regimen for a febrile infant in their first two weeks—and even into their first month—of life for empiric treatment of herpes simplex virus (HSV).

But what happens after those first four weeks? Should febrile infants older than a month also get empiric acyclovir and PCR testing for HSV, or are there clinical indicators (e.g. encephalitic signs) that would suggest a non-empiric approach reserved for febrile infants with observable neurologic concerns?

Gaensbauer et al. (doi: 10.1542/peds.2014-0294) looks into the use of empiric acyclovir for older infants and children using cases identified at 15 children’s hospitals via the Pediatric Health Information System (PHIS) database to identify factors associated with unnecessary testing and treatment for HSV. The results suggest we might do with less empiric acyclovir, and in turn, less cost to patients without compromising quality or missing a case of HSV that would not be as subtle as in early infancy.

Read the study and decide if you can reduce your own empiric use of acyclovir or not.

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