Clinical Pharmacology of Aciclovir in Infants and Children - Abstract
Aciclovir is an acyl guanine nucleoside analogue that lacks the 2’ and 3’ positions normally supplied by ribose. Aciclovir is the prototype of a group of antiviral agents that are nucleoside congeners that are phosphorylated intracellularly by a viral kinase and subsequently by host cell enzymes to become inhibitors of viral DNA synthesis. Aciclovir is most active against herpes simplex virus-1 and has been used to treat varicella zoster and Epstein-Barr viruses. The intravenous dose of acyclovir is 30 mg/kg thrice-daily in infants. In children the dose varies according to the virus to be treated and the oral dose ranges from 200 to 800 mg 4 or 5 timesdaily to treat varicella zoster infection and increases with child age. Aciclovir elimination half-life ranges from about 10 to 3 hours in infants, decreases with infant maturation, and in children it is about 1.5 hours. Aciclovir interacts with drugs and may induce nephrotoxicity. The treatment and the prophylaxis with aciclovir have been extensively studied in infants and children. Aciclovir penetrates into the cerebrospinal fluid in significant amounts and cured encephalitis caused by herpes simplex virus and meningitis due to herpes zoster virus. This drug crosses the placenta and migrates into the breast-milk. The aim of this study is to review of acyclovir dosing, efficacy, safety, adverse-effects, pharmacokinetics, metabolism, drug-interactions, toxicity, treatment, prophylaxis, penetration into the cerebrospinal fluid, treatment of meningitis, in infants and children, placental transfer, and migration into the breast-milk.