Use of cidofovir in pediatric patients with adenovirus infection [version 1; referees: 2 approved]
Background: Adenoviruses contribute to morbidity and mortality among immunocompromised pediatric patients including stem cell and solid organ transplant recipients. Cidofovir (CDV), an antiviral compound approved by the FDA in 1996, is used for treatment of adenoviral (ADV) infections in immunocompr...
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doaj-8c21818c54cc48abb7d142b18f1000cb2020-11-25T04:00:12ZengF1000 Research LtdF1000Research2046-14022016-04-01510.12688/f1000research.8374.19007Use of cidofovir in pediatric patients with adenovirus infection [version 1; referees: 2 approved]Lakshmi Ganapathi0Alana Arnold1Sarah Jones2Al Patterson3Dionne Graham4Marvin Harper5Ofer Levy6Harvard Medical School, Boston, MA, USADivision of Pharmacy, Boston Children’s Hospital, Boston, MA, USADivision of Pharmacy, Boston Children’s Hospital, Boston, MA, USADivision of Pharmacy, Boston Children’s Hospital, Boston, MA, USAProgram for Patient Quality and Safety, Boston Children’s Hospital, Boston, MA, USAHarvard Medical School, Boston, MA, USAHarvard Medical School, Boston, MA, USABackground: Adenoviruses contribute to morbidity and mortality among immunocompromised pediatric patients including stem cell and solid organ transplant recipients. Cidofovir (CDV), an antiviral compound approved by the FDA in 1996, is used for treatment of adenoviral (ADV) infections in immunocompromised patients despite concern of potential nephrotoxicity. Methods: We conducted a retrospective 5-year review at Boston Children’s Hospital of 16 patients (mean age = 6.5 years) receiving 19 courses of CDV. During therapy all pertinent data elements were reviewed to characterize potential response to therapy and incidence of renal dysfunction. Results: Of the 19 CDV courses prescribed, 16 courses (84%) were in patients who had a positive blood ADV Polymerase chain reaction (PCR) alone or in combination with positive ADV PCR/ Direct Immunofluorescence Assay (DFA) at another site. Respiratory symptoms with or without pneumonia were the most common presentation (10/19, 53%). In the majority of blood positive courses (10/16, 63%), viral clearance was also accompanied by clinical response. This was not the case in four courses where patients expired despite viral clearance, including one in which death was directly attributable to adenovirus. There was reversible renal dysfunction observed during the use of CDV. Conclusions: CDV appeared safe and reasonably tolerated for treatment of ADV in this pediatric population and was associated with viral response and clinical improvement in the majority of patients but reversible renal dysfunction was a side effect. Further studies of the efficacy of CDV for immunocompromised children with ADV infection are warranted.http://f1000research.com/articles/5-758/v1Pediatric Infectious DiseasesRespiratory Pharmacology |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Lakshmi Ganapathi Alana Arnold Sarah Jones Al Patterson Dionne Graham Marvin Harper Ofer Levy |
spellingShingle |
Lakshmi Ganapathi Alana Arnold Sarah Jones Al Patterson Dionne Graham Marvin Harper Ofer Levy Use of cidofovir in pediatric patients with adenovirus infection [version 1; referees: 2 approved] F1000Research Pediatric Infectious Diseases Respiratory Pharmacology |
author_facet |
Lakshmi Ganapathi Alana Arnold Sarah Jones Al Patterson Dionne Graham Marvin Harper Ofer Levy |
author_sort |
Lakshmi Ganapathi |
title |
Use of cidofovir in pediatric patients with adenovirus infection [version 1; referees: 2 approved] |
title_short |
Use of cidofovir in pediatric patients with adenovirus infection [version 1; referees: 2 approved] |
title_full |
Use of cidofovir in pediatric patients with adenovirus infection [version 1; referees: 2 approved] |
title_fullStr |
Use of cidofovir in pediatric patients with adenovirus infection [version 1; referees: 2 approved] |
title_full_unstemmed |
Use of cidofovir in pediatric patients with adenovirus infection [version 1; referees: 2 approved] |
title_sort |
use of cidofovir in pediatric patients with adenovirus infection [version 1; referees: 2 approved] |
publisher |
F1000 Research Ltd |
series |
F1000Research |
issn |
2046-1402 |
publishDate |
2016-04-01 |
description |
Background: Adenoviruses contribute to morbidity and mortality among immunocompromised pediatric patients including stem cell and solid organ transplant recipients. Cidofovir (CDV), an antiviral compound approved by the FDA in 1996, is used for treatment of adenoviral (ADV) infections in immunocompromised patients despite concern of potential nephrotoxicity. Methods: We conducted a retrospective 5-year review at Boston Children’s Hospital of 16 patients (mean age = 6.5 years) receiving 19 courses of CDV. During therapy all pertinent data elements were reviewed to characterize potential response to therapy and incidence of renal dysfunction. Results: Of the 19 CDV courses prescribed, 16 courses (84%) were in patients who had a positive blood ADV Polymerase chain reaction (PCR) alone or in combination with positive ADV PCR/ Direct Immunofluorescence Assay (DFA) at another site. Respiratory symptoms with or without pneumonia were the most common presentation (10/19, 53%). In the majority of blood positive courses (10/16, 63%), viral clearance was also accompanied by clinical response. This was not the case in four courses where patients expired despite viral clearance, including one in which death was directly attributable to adenovirus. There was reversible renal dysfunction observed during the use of CDV. Conclusions: CDV appeared safe and reasonably tolerated for treatment of ADV in this pediatric population and was associated with viral response and clinical improvement in the majority of patients but reversible renal dysfunction was a side effect. Further studies of the efficacy of CDV for immunocompromised children with ADV infection are warranted. |
topic |
Pediatric Infectious Diseases Respiratory Pharmacology |
url |
http://f1000research.com/articles/5-758/v1 |
work_keys_str_mv |
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