Table 1.
Characteristics of included patients, their treatment and CSF concentrations of aciclovir (ACV) and CMMG at all sampling timepoints
Patient | Age (years) | Gender | Weight (kg) | Indication for treatment | ACV dose q8h (mg/kg) | Lag time from dose to sampling (h) | Treatment duration (days) | Estimated CLCR (mL/min) | RIFLE | Serum concentration (μmol/L) |
CSF concentration (μmol/L) |
CSF:serum albumin ratio×10-3 | Neuropsychiatric symptoms during treatment | ||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
ACV | CMMG | ACV | CMMG | ||||||||||||
1a | 70 | M | 56 | herpes encephalitis | 10 | 7.5 | 13 | 80 | R | 5.7 | 0.74 | 8.4 | 0.15 | N/A | |
1b | 10 | 9 | 20 | 71 | 2.7 | 0.29 | 7.1 | <0.15 | 15.4 | ||||||
1c | 10 | 8.5 | 27 | 57 | 5 | 0.59 | 8.5 | <0.15 | 11.7 | ||||||
2 | 79 | F | 52 | herpes encephalitis | 11 | 6.5 | 9 | 61 | R | 70 | 12 | 11 | 0.27 | 7 | |
3 | 66 | M | 89 | suspected varicella meningitis | 1000d | 1 | 14 | 84 | F | 29 | 1.7 | 3.1 | <0.15 | 6.9 | |
4a | 35 | M | 98 | herpes encephalitis | 15 | 6 | 2 | 30 | F | 110 | 57 | 40 | 3.3 | 29.4 | confusion, improved at dose adjustment |
4b | 12 | 7.5 | 9 | 125 | 25 | 2.8 | 7.5 | 0.15 | 15.7 | ||||||
4c | 12 | 8 | 16 | 149 | 10 | 1.5 | 10 | 0.19 | 23.8 | ||||||
5 | 30 | M | 100 | suspected encephalitis | 10 | 6 | 3 | 109 | 9.6 | 1.3 | 6.7 | <0.15 | 24.3 | ||
6a | 64 | F | 60 | herpes encephalitis | 12 | 3.5 | 3 | 40 | R | 50 | 9.7 | 24 | 0.68 | 20.1 | confusion, improved at end of treatment |
6b | 12 | 4 | 13 | 65 | 18.6 | 2.7 | 14 | 0.3 | 15.4 | ||||||
6c | 12 | 8 | 21 | 70 | 11 | 2.3 | 12 | 0.23 | 11.9 | ||||||
7a | 65 | M | 76 | recurrent herpes encephalitis | 15 | 2.5 | 8 | 109 | I | 55 | 18 | 16 | 0.29 | 14.7 | confusion, improved at end of treatment |
7b | 15 | 4.5 | 15 | 51 | 120 | 38 | 29 | 1 | 10.5 | ||||||
7c | 15 | 21 | 29 | 35 | 11 | 11 | 8.2 | 0.66 | 14.6 | ||||||
8 | 55 | M | 77 | herpes encephalitis | 10 | 5.5 | 13 | 122 | 11 | 1 | 6.7 | <0.15 | 7.4 | ||
9a | 58 | M | 68 | stroke | 11 | 1 | 5 | 56 | 75 | 10 | 12 | 0.27 | 9.3 | ||
9b | 10 | 6.5 | 11 | 52 | 20 | 5 | 11 | 0.26 | 11.7 | ||||||
10 | 40 | M | 120 | herpes meningoencephalitis | 10 | 1 | 12 | 184 | 13 | 0.9 | 8.5 | <0.15 | 9.6 | ||
11 | 41 | F | 67 | herpes meningitis | 10 | 4.5 | 7 | 117 | 14 | 1.5 | 17 | 0.77 | 26.7 | ||
12 | 67 | M | 78 | suspected encephalitis | 9 | 1.5 | 5 | 87 | 31 | 4.9 | 8.9 | 0.17 | 13.8 | ||
13 | 26 | F | 50 | suspected encephalitis | 15 | 8 | 3 | 119 | 6.1 | 1.2 | 5.9 | <0.15 | 8.6 | ||
14 | 58 | M | 87 | herpes meningitis | 1000d | 1 | 10e | 115 | 13 | 2 | 4.8 | <0.15 | 8.6 | ||
15a | 65 | F | 67 | herpes encephalitis | 9 | 6 | 6 | 73 | 10 | 2.3 | 7.7 | 0.16 | 8.5 | ||
15b | 9 | 3 | 11 | 79 | 40 | 5.4 | 7.6 | <0.15 | 8.8 | ||||||
16 | 39 | F | 77 | herpes encephalitis | 14 | 1 | 13 | 131 | N/A | N/A | 8 | <0.15 | 22.5 | ||
17 | 49 | F | 72 | herpes meningitis | 9 | 1.5 | 3 | 129 | 17 | 1.6 | 7.5 | <0.15 | 4.1 | ||
18 | 53 | M | 85 | varicella meningitis | 14 | 5.5 | 2 | 123 | N/A | N/A | 14 | 0.24 | 13.3 | ||
19a | 75 | F | 57 | varicella encephalitis | 10 | 7 | 7 | 54 | Rf | 15 | 5.2 | 28 | 6.4 | 162.4 | confusion, improved at end of treatment |
19b | 10 | 7 | 14 | 68 | 13 | 3.6 | 27 | 3.8 | 108.1 | ||||||
20a | 55 | F | 68 | Ramsay Hunt syndrome | 14 | 2.5 | 2 | 131 | F | 31 | 3.8 | 6.5 | <0.15 | 1.7 | anxiety, improved slowly at end of treatment |
20b | 5 | 3 | 9 | 60 | 12 | 3 | 3.3 | <0.15 | 1.4 | ||||||
21a | 38 | M | 81 | varicella encephalitis | 14 | 4.5 | 1 | 141 | 9.9 | 1.1 | 12 | 0.2 | 28.8 | ||
21b | 14 | 2.5 | 3 | 135 | 19 | 1.9 | 14 | 0.24 | 18 |
ACV dose, mg iv aciclovir per kg body weight in a single dose, administered three times daily, except in patient 20b, where doses were administered twice daily; N/A, not available; M, male; F, female; (RIFLE column) R, risk; I, injury; F, failure; shaded areas indicate patients assessed to have AINS.
First sampling in patient where repeated sampling was performed.
Second sampling.
Third sampling.
Treatment with oral valaciclovir in single dose (mg), three times daily.
Patient had previously received valaciclovir in a lower dose regimen as prophylaxis.
Patient did not fulfil RIFLE criteria based on creatinine, but calculation of GFR according to cystatin C CAPA estimated GFR at 30 mL/min, corresponding to at least risk of acute kidney failure.