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Vidarabine versus acyclovir in herpes simplex encephalitis
32 Infectious Diseases Newsletter 5(4) A p r i l 1986
COMMENTS ON CURRENT PUBLICATIONS Gerards L J, Cats BP, HoogkampKorstanje JAA: Early neonatal group B streptococcal disease: degree of colonisation as an important determinant. J Infect 11:119-124, 1985. Over a 5-year period, 145 of 1,150 infants admitted to an intensive care unit yielded group B Streptococcus spp. (GBS). Of these, 21 had early-onset disease, 19 had probable sepsis, 5 had delayed-onset disease, and 100 did not develop disease. Acquisition from the mother was assumed in the 87 infants whose immediate post-partum cultures yielded GBS; 21 developed earlyonset disease, 19 probable sepsis, and 47 no disease. Prolonged rupture of the membranes resulted in a significantly higher frequency of GBS disease. Both the frequency of positive cultures (throat, nose, ear, eye, skin, umbilicus, rectum) and the density of growth were significantly greater in those infants who developed disease.
herpes simplex encephalitis. N Engl J Med 314:144-149, 1986. Of 69 patients with biopsy-proven herpes simplex encephalitis, 37 were treated with vidarabine (15 mg/kg body weight per day) and 32 were treated with acyclovir (30 mg/kg body weight per day) for 10 days. A significantly greater reduction in both morbidity and mortality resulted from treatment with acyclovir as compared with vidarabine. Shepp DH, Dandliker PS, Meyers JD: Treatment of variceila-zoster virus infection in severely immunocompromised patients. A randomized comparison of acyclovir and vidarabine. N Engl J Med 314:208-212, 1986. Treatment groups of 11 patients each were assigned randomly and prospectively to receive either vidarabine (10 mg/kg body weight
per day) or acyclovir (1.5 g / m 2 body surface per day). Acyclovir was significantly more effective than vidarabine in the prevention of dissemination, and in the promotion of healing and the relief of pain of the cutaneous lesions. Comment Acyclovir, both more active as an antiviral and more soluble in water than vidarabine, proved also to be more effective in the treatment of herpes simplex encephalitis and in varicella-zoster infection in immunocompromised patients. The potential for development of resistance to acyclovir has yet to be assessed fully, and it is possible that acyclovir may affect renal function adversely. PDH []
General Information
Comment These results extend prior observations that showed transmission of GBS from mother to infant was favored by heavy vaginal carriage; further, there was an increased risk of GBS disease in neonates from premature labor, intrapartum fever, twin pregnancy, and lack of transplacental acquisition of type-specific antibodies by the fetus. The authors support the suggestion that the intrapartum administration of ampicillin might prevent early-onset disease from GBS. PDH [] Whitley RJ, Alford CA, Hirsch MS, et al: Vidarabine versus acyclovir in
Infectious Diseases Newsletter is published monthly by Elsevier Science Publishing ( o . ln~. 52 Vanderbih Avenue, New York, NY 10017. Please see inside front cover for subscription information This newsletter has been registered with the Copyright Clearance Center Inc. Consent ,s gi',en for copying of articles for personal or internal use, or for the personal or internal use of spccitic clients. This consent is given on the condition that the copier pay through the Center the per-page fee stated in the code on each page for copying beyond that permitted by the US Copyright Law. If no code appears on an article, the author has not given broad consent to copy and permission to copy must be obtained directly from the author. This consent does not extend to other kinds of copying, such as for general distribution, resale, advertising and promotional purposes, or for creating new collective works. Address orders, changes of address, and claims for missing issues to Journals I:ullillment Department, Elsevier Science Publishing Co., Inc., 52 Vanderbilt Avenue, Ne,x York, NY I(X)I 7 Claims for missing issues can be honored only up to three months for domestic addresses and six m o n t h s for foreign addresses. Duplicate copies will not be sent to replace those undelivcrcd because of failure to notify Elsevier of change of address. Address editorial correspondence to Paul D. Hoeprich, MD, Professor of Medicine and Pathology, University of California Medical Center, Division of Infectious Disease, Department of Internal Medicine, 4301 X Street, Sacramento, CA 95817.
Nottce. Views expressed within are the responsibility of the authors. Every' effort has been made to ensure the accuracy of the information. The publisher, however, must disclaim any responsibility or liability. Readers are advised to check the product information sheet of each drug before administration. Infectious Diseases Newsletter is included in BIOSIS
1986 Elsevier Science Publishing Co., Inc. 0278-2316/86/$0.00 + 2.20
COMMENTS ON CURRENT PUBLICATIONS Gerards L J, Cats BP, HoogkampKorstanje JAA: Early neonatal group B streptococcal disease: degree of colonisation as an important determinant. J Infect 11:119-124, 1985. Over a 5-year period, 145 of 1,150 infants admitted to an intensive care unit yielded group B Streptococcus spp. (GBS). Of these, 21 had early-onset disease, 19 had probable sepsis, 5 had delayed-onset disease, and 100 did not develop disease. Acquisition from the mother was assumed in the 87 infants whose immediate post-partum cultures yielded GBS; 21 developed earlyonset disease, 19 probable sepsis, and 47 no disease. Prolonged rupture of the membranes resulted in a significantly higher frequency of GBS disease. Both the frequency of positive cultures (throat, nose, ear, eye, skin, umbilicus, rectum) and the density of growth were significantly greater in those infants who developed disease.
herpes simplex encephalitis. N Engl J Med 314:144-149, 1986. Of 69 patients with biopsy-proven herpes simplex encephalitis, 37 were treated with vidarabine (15 mg/kg body weight per day) and 32 were treated with acyclovir (30 mg/kg body weight per day) for 10 days. A significantly greater reduction in both morbidity and mortality resulted from treatment with acyclovir as compared with vidarabine. Shepp DH, Dandliker PS, Meyers JD: Treatment of variceila-zoster virus infection in severely immunocompromised patients. A randomized comparison of acyclovir and vidarabine. N Engl J Med 314:208-212, 1986. Treatment groups of 11 patients each were assigned randomly and prospectively to receive either vidarabine (10 mg/kg body weight
per day) or acyclovir (1.5 g / m 2 body surface per day). Acyclovir was significantly more effective than vidarabine in the prevention of dissemination, and in the promotion of healing and the relief of pain of the cutaneous lesions. Comment Acyclovir, both more active as an antiviral and more soluble in water than vidarabine, proved also to be more effective in the treatment of herpes simplex encephalitis and in varicella-zoster infection in immunocompromised patients. The potential for development of resistance to acyclovir has yet to be assessed fully, and it is possible that acyclovir may affect renal function adversely. PDH []
General Information
Comment These results extend prior observations that showed transmission of GBS from mother to infant was favored by heavy vaginal carriage; further, there was an increased risk of GBS disease in neonates from premature labor, intrapartum fever, twin pregnancy, and lack of transplacental acquisition of type-specific antibodies by the fetus. The authors support the suggestion that the intrapartum administration of ampicillin might prevent early-onset disease from GBS. PDH [] Whitley RJ, Alford CA, Hirsch MS, et al: Vidarabine versus acyclovir in
Infectious Diseases Newsletter is published monthly by Elsevier Science Publishing ( o . ln~. 52 Vanderbih Avenue, New York, NY 10017. Please see inside front cover for subscription information This newsletter has been registered with the Copyright Clearance Center Inc. Consent ,s gi',en for copying of articles for personal or internal use, or for the personal or internal use of spccitic clients. This consent is given on the condition that the copier pay through the Center the per-page fee stated in the code on each page for copying beyond that permitted by the US Copyright Law. If no code appears on an article, the author has not given broad consent to copy and permission to copy must be obtained directly from the author. This consent does not extend to other kinds of copying, such as for general distribution, resale, advertising and promotional purposes, or for creating new collective works. Address orders, changes of address, and claims for missing issues to Journals I:ullillment Department, Elsevier Science Publishing Co., Inc., 52 Vanderbilt Avenue, Ne,x York, NY I(X)I 7 Claims for missing issues can be honored only up to three months for domestic addresses and six m o n t h s for foreign addresses. Duplicate copies will not be sent to replace those undelivcrcd because of failure to notify Elsevier of change of address. Address editorial correspondence to Paul D. Hoeprich, MD, Professor of Medicine and Pathology, University of California Medical Center, Division of Infectious Disease, Department of Internal Medicine, 4301 X Street, Sacramento, CA 95817.
Nottce. Views expressed within are the responsibility of the authors. Every' effort has been made to ensure the accuracy of the information. The publisher, however, must disclaim any responsibility or liability. Readers are advised to check the product information sheet of each drug before administration. Infectious Diseases Newsletter is included in BIOSIS
1986 Elsevier Science Publishing Co., Inc. 0278-2316/86/$0.00 + 2.20