Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

PART I: BY DRUGABACAVIRFor up-to-date information on the use of antiretrovirals, consult an HIV expert or www.aidsinfo.nih.gov/ABACAVIR/LAMIVUDINE (Epzicom ® ) – non-formulary at UWHCFor up-to-date information on the use of antiretrovirals, consult an HIV expert or www.aidsinfo.nih.gov/ABACAVIR/LAMIVUDINE/ZIDOVUDINE (Trizivir®) – non-formulary at UWHCFor up-to-date information on the use of antiretrovirals, consult an HIV expert or www.aidsinfo.nih.gov/ACYCLOVIRUsual DoseAdult: 200 mg Q4H PO five doses per day, 400 mg PO TID or 800 mg five times daily PO (UWHC cost/day $0.46-1.15)OR 5-12 mg/kg Q8H IV (UWHC cost/day $7.31-17.54)Pediatric: 20 mg/kg/day (maximum 800 mg/dose) PO/IV in divided doses four times daily or 25-50 mg/kg/day IV in divideddoses Q8HIndications1. Herpes simplex encephalitis (10-12 mg/kg Q8H IV x 21 days). In children 3 months to 12 years old, the dose is 20mg/kg every 8 hours for 10 days.2. Herpes simplex (severe mucosal or cutaneous)a. Immunocompromised or burn patients (5 mg/kg Q8H IV x 7-14 days).b. In select immunocompetent patients, such as for eczema herpeticum, proctitis, severe primary oral or periorbitalherpes or other severe mucosal or cutaneous disease (20 mg/kg/dose, up to 800 mg, four times daily PO x 5 days OR5 mg/kg/dose Q8H IV).3. Herpes simplex (genital herpes)a. Immunocompetenti. Initial acute, mild/moderate (200 mg 5 times daily PO x 10 days OR 400 mg TID PO x 10 days). Initial acute,severe (5 mg/kg Q8H IV x 5 days).ii. Chronic recurrent, prophylaxis (400 mg BID PO for up to 6 months, then reassess need).iii. Episodic (200 mg Q4H PO 5 times daily x 5 days OR 400 mg TID PO x 5 days).b. Immunocompromisedi. Acute, severe (5 mg/kg Q8H IV x 7 days).4. Varicella (chicken pox)a. Immunocompromised children (500 mg/m 2 Q8H IV over 1 hour x 7-10 days).b. In selected immunocompetent pediatric or adult patients (20 mg/kg/dose, up to 800 mg, five times daily PO x 7 days– begin within the first 24 hours of onset of rash).c. Varicella (chicken pox) pneumonia, immunocompetent (10 mg/kg Q8H IV x 7 days).5. Herpes zoster (shingles)a. Immunocompetent (800 mg 5 times daily PO x 7-10 days); must be started within 72 hours of onset.b. Immunocompromised (10-12 mg/kg Q8H IV x 7 days).c. Immunocompromised - disseminated, severe localized (but >1 dermatome), or involving ophthalmic division of thetrigeminal nerve (10 mg/kg Q8H IV x 7 days).6. Cytomegalovirus prophylaxis in transplant patients (800 mg four times daily PO x 3 months).7. Herpes simplex prophylaxis for bone marrow transplant recipients (400 mg four times daily PO).8. Neonatal herpes (20 mg/kg/dose Q8H IV x 14-21 days).CommentsDose adjustment required for renal impairment. See renal dosing guideline on uconnect.With high dose (>10 mg/kg) IV therapy, administer over 60 minutes and maintain hydration to prevent urine crystallization.For obese patients the 10 mg/kg IV dose is based on ideal body weight. Maximum dose is 500 mg/m 2 . Concomitant useof ganciclovir and acyclovir is unnecessary, and increases costs and toxicity. In general, it is not considered necessary totreat uncomplicated, single dermatome (unless trigeminal) herpes zoster in immunocompetent children or adolescents orpregnant women.