Document Detail


Inadequacy of plasma acyclovir levels at delivery in patients with genital herpes receiving oral acyclovir suppressive therapy in late pregnancy.
MedLine Citation:
PMID:  20085679     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Acyclovir therapy in late pregnancy among women with recurrent genital herpes is effective in decreasing genital lesion frequency and subclinical viral shedding rates at delivery, thereby decreasing the need for Caesarean section. Despite good adherence and increased dosing schedules, breakthrough lesions and viral shedding are still observed in some women at or near delivery. Anecdotal evidence suggests that low levels of herpes simplex virus replication at delivery may result in transmission to the neonate. Therefore, defining optimal acyclovir dosing during labour and delivery is warranted. Our objectives were to determine actual maternal and fetal acyclovir levels at delivery, and explore associations between acyclovir levels, duration of labour, and time since last acyclovir dose.
METHODS: Twenty-seven patients were prescribed oral acyclovir 400 mg three times daily from 36 weeks' gestation. Cord blood (venous and arterial) and maternal venous blood samples were collected at delivery, and acyclovir levels measured using capillary electrophoresis. Correlations between duration of labour, and time since last acyclovir dose with acyclovir blood levels were calculated.
RESULTS: Acyclovir levels were below the published mean steady-state trough value (180 ng/mL) in 52% of venous cord samples, 55% of arterial cord samples, and 36% of maternal samples. There was a significant inverse correlation between the time since last dose and venous cord levels (rs19 = -0.57, P < 0.015), arterial cord levels (rs16 = -0.63, P < 0.01), and maternal acyclovir levels (r10 = -0.69, P < 0.03).
CONCLUSION: Oral dosing of acyclovir in women in late pregnancy may result in insufficient levels at delivery to prevent viral shedding. Alternative approaches that incorporate acyclovir dosing through labour, either through oral or intravenous administration, should be evaluated to assess effects on viral shedding.
Authors:
Daniel T Leung; Paul A Henning; Emily C Wagner; Audrey Blasig; Anna Wald; Stephen L Sacks; Lawrence Corey; Deborah M Money
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC     Volume:  31     ISSN:  1701-2163     ISO Abbreviation:  J Obstet Gynaecol Can     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2010-01-20     Completed Date:  2010-02-26     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  101126664     Medline TA:  J Obstet Gynaecol Can     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  1137-43     Citation Subset:  IM    
Affiliation:
Department of Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.
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MeSH Terms
Descriptor/Qualifier:
Acyclovir / administration & dosage*,  blood
Administration, Oral
Adult
Antiviral Agents / administration & dosage*,  blood
Cohort Studies
Delivery, Obstetric
Dose-Response Relationship, Drug
Female
Fetal Blood / chemistry
Herpes Genitalis / drug therapy*,  prevention & control,  transmission
Humans
Infant, Newborn
Infectious Disease Transmission, Vertical / prevention & control*
Labor, Obstetric
Pregnancy
Pregnancy Complications, Infectious / drug therapy*
Recurrence
Simplexvirus
Treatment Outcome
Virus Shedding
Grant Support
ID/Acronym/Agency:
P01 AI030731-17/AI/NIAID NIH HHS; P01-AI30731/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/Antiviral Agents; 59277-89-3/Acyclovir
Comments/Corrections

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