Acyclovir in the therapy of varicella zoster-caused disease in children undergoing immunosuppressive therapy
Nyerges, G.; Mészner, Z.; Gyarmati, E.; Kerpel-Fronius, S.
Orvosi Hetilap 128(40): 2083-2088
1987
ISSN/ISBN: 0030-6002 PMID: 3313190 Document Number: 291441
Open and double blind studies were carried out with iv acyclovir (Zovirax) in varicella-zoster virus infections of immunocompromised children. The purpose of the open study was to determine the impact of iv. acyclovir treatment on the progressive varicella or generalised zoster of immunocompromised children. Out of 48 such patients treated with acyclovir 2, while out of 32 untreated patients of a historical control group 9 died due to the varicella zoster virus infection. The difference between the two groups was statistically significant (p < 0.01) in favour of the acyclovir treatment. The double blind study was undertaken in order to investigate whether early administration of acyclovir would prevent cutaneous progression and visceral dissemination of primary varicella infection in immunocompromised patients. Fifty immunocompromised patients with varicella exhibiting no sign of progression were treated with iv. acyclovir or placebo in the double blind randomised study. Due to signs of progression 12 out of the 25 patients in the placebo group had to be withdrawn from the study and given open acyclovir, while only one out of 25 acyclovir treated patients was withdrawn for similar reason. The difference between the acyclovir and placebo group in respect of preventing the progression of varicella was significant (p < 0.001) in favour of the acyclovir treatment. One patient of the placebo group died, in spite of open acyclovir treatment from the 2nd day on. The child suffered of non Hodgkin lymphoma and autopsy revealed disseminated visceral varicella and a severe lymphocyte depletion of the lymphoid organs. In the double blind study other parameters (e.g. rash progression, the physician's evaluation of efficacy) also proved the efficacy of acyclovir treatment. In 3 cases one or more relapses of the varicella zoster virus infection were observed after a successful early treatment. Relapses could be cured with acyclovir or vidarabine in each case. The authors suggest that all immunocompromised children with varicella should receive early acyclovir treatment.