FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 324:444-449 February 14, 1991 Number 7 Next

	Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

Abstract

BACKGROUND. Despite the use of vidarabine, herpes simplex virus (HSV) infection in neonates continues to be a disease of high morbidity and mortality. We undertook a controlled trial comparing vidarabine with acyclovir for the treatment of neonatal HSV infection. METHODS. Babies less than one month of age with virologically confirmed HSV infection were randomly and blindly assigned to receive either intravenous vidarabine (30 mg per kilogram of body weight per day; n = 95) or acyclovir (30 mg per kilogram per day; n = 107) for 10 days. Actuarial rates of mortality and morbidity among the survivors after one year were compared overall and according to the extent of the disease at entry into the study (infection confined to the skin, eyes, or mouth; encephalitis; or disseminated disease). RESULTS. After adjustment for differences between groups in the extent of disease, there was no difference between vidarabine and acyclovir in either morbidity (P = 0.83) or mortality (P = 0.27). None of the 85 babies with disease confined to the skin, eyes, or mouth died. Of the 31 babies in this group who were treated with vidarabine and followed for a year, 88 percent (22 of 25) were judged to be developing normally after one year, as compared with 98 percent (45 of 46) of the 54 treated with acyclovir (95 percent confidence interval for the difference, -4 to 24). For the 71 babies with encephalitis, mortality was 14 percent with vidarabine (5 of 36) and with acyclovir (5 of 35); of the survivors, 43 percent (13 of 30) and 29 percent (8 of 28), respectively, were developing normally after one year (95 percent confidence interval for the difference, -11 to 39). For the 46 babies with disseminated disease, mortality was 50 percent (14 of 28) with vidarabine and 61 percent (11 of 18) with acyclovir (95 percent confidence interval for the difference, -20 to 40); of the survivors, 58 percent (7 of 12) and 60 percent (3 of 5), respectively, were judged to be developing normally after one year (95 percent confidence interval for the difference, -40 to 50). Both medications were without serious toxic effects. CONCLUSIONS. In this multicenter, randomized, blinded study there were no differences in outcome between vidarabine and acyclovir in the treatment of neonatal HSV infection. The study lacked statistical power to determine whether there were sizable differences within the subgroups of those with localized HSV, encephalitis, or disseminated disease.

Source Information

Department of Pediatrics, University of Alabama, Birmingham.

This article has been cited by other articles:

• Caviness, A. C., Demmler, G. J., Swint, J. M., Cantor, S. B. (2008). Cost-effectiveness Analysis of Herpes Simplex Virus Testing and Treatment Strategies in Febrile Neonates. Arch Pediatr Adolesc Med 162: 665-674 [Abstract] [Full Text]  
• Tita, A. T. N., Grobman, W. A., Rouse, D. J. (2006). Antenatal herpes serologic screening: an appraisal of the evidence.. Obstet Gynecol 108: 1247-1253 [Abstract] [Full Text]  
• Kropp, R. Y., Wong, T., Cormier, L., Ringrose, A., Burton, S., Embree, J. E., Steben, M. (2006). Neonatal herpes simplex virus infections in Canada: results of a 3-year national prospective study.. Pediatrics 117: 1955-1962 [Abstract] [Full Text]  
• Burgos, J. S., Ramirez, C., Guzman-Sanchez, F., Alfaro, J. M., Sastre, I., Valdivieso, F. (2006). Hematogenous Vertical Transmission of Herpes Simplex Virus Type 1 in Mice. J. Virol. 80: 2823-2831 [Abstract] [Full Text]  
• Fonseca-Aten, M., Messina, A. F., Jafri, H. S., Sanchez, P. J. (2005). Herpes Simplex Virus Encephalitis During Suppressive Therapy With Acyclovir in a Premature Infant. Pediatrics 115: 804-809 [Abstract] [Full Text]  
• Kimberlin, D. W. (2004). Neonatal Herpes Simplex Infection. Clin. Microbiol. Rev. 17: 1-13 [Abstract] [Full Text]  
• Kimura, H, Futamura, M, Ito, Y, Ando, Y, Hara, S, Sobajima, H, Nishiyama, Y, Morishima, T (2003). Relapse of neonatal herpes simplex virus infection. Arch. Dis. Child. Fetal Neonatal Ed. 88: F483-486 [Abstract] [Full Text]  
• Letai, A. G., Snyder, K. M., Fett, J. D., Worthington, M. G., Ross, J. J., Neff, J. M., Lane, J. M., Fulginiti, V. A., Milton, D. K., Bozzette, S. A., Boer, R., Mack, T., Sepkowitz, K. A. (2003). Smallpox and Smallpox Vaccination. NEJM 348: 1920-1925 [Full Text]  
• Brown, Z. A., Wald, A., Corey, L. (2003). Cesarean Delivery and Risk of Herpes Simplex Virus Infection--Reply. JAMA 289: 2208-2209 [Full Text]  
• Fisman, D N, Hook, E W III, Goldie, S J (2003). Estimating the costs and benefits of screening monogamous, heterosexual couples for unrecognised infection with herpes simplex virus type 2. Sex. Transm. Infect. 79: 45-52 [Abstract] [Full Text]  
• Kimberlin, D. W., Lin, C.-Y., Jacobs, R. F., Powell, D. A., Frenkel, L. M., Gruber, W. C., Rathore, M., Bradley, J. S., Diaz, P. S., Kumar, M., Arvin, A. M., Gutierrez, K., Shelton, M., Weiner, L. B., Sleasman, J. W., de Sierra, T. M., Soong, S.-J., Kiell, J., Lakeman, F. D., Whitley, R. J., the National Institute of Allergy and Infectious D, (2001). Natural History of Neonatal Herpes Simplex Virus Infections in the Acyclovir Era. Pediatrics 108: 223-229 [Abstract] [Full Text]  
• Kimberlin, D. W., Lin, C.-Y., Jacobs, R. F., Powell, D. A., Corey, L., Gruber, W. C., Rathore, M., Bradley, J. S., Diaz, P. S., Kumar, M., Arvin, A. M., Gutierrez, K., Shelton, M., Weiner, L. B., Sleasman, J. W., de Sierra, T. M., Weller, S., Soong, S.-J., Kiell, J., Lakeman, F. D., Whitley, R. J., the National Institute of Allergy and Infectious D, (2001). Safety and Efficacy of High-Dose Intravenous Acyclovir in the Management of Neonatal Herpes Simplex Virus Infections. Pediatrics 108: 230-238 [Abstract] [Full Text]  
• Kurokawa, M., Hozumi, T., Tsurita, M., Kadota, S., Namba, T., Shiraki, K. (2001). Biological Characterization of Eugeniin as an Anti-Herpes Simplex Virus Type 1 Compound in Vitro and in Vivo. J. Pharmacol. Exp. Ther. 297: 372-379 [Abstract] [Full Text]  
• Mindel, A, Taylor, J, Tideman, R L, Seifert, C, Berry, G, Wagner, K, Page, J, Marks, C, Trudinger, B, Cunningham, A (2000). Neonatal herpes prevention: a minor public health problem in some communities. Sex. Transm. Infect. 76: 287-291 [Abstract] [Full Text]  
• von Sadovszky, V., Carlson-Dakes, K., Keller, M. L. (2000). Beliefs about HSV and HPV and Sexual Behavior Among Incarcerated Adolescent Women. JOURNAL OF CORRECTIONAL HEALTH CARE 7: 37-60 [Abstract]  
• Corey, L., Handsfield, H. H. (2000). Genital Herpes and Public Health: Addressing a Global Problem. JAMA 283: 791-794 [Abstract] [Full Text]  
• Tang, Y.-W., Mitchell, P. S., Espy, M. J., Smith, T. F., Persing, D. H. (1999). Molecular Diagnosis of Herpes Simplex Virus Infections in the Central Nervous System. J. Clin. Microbiol. 37: 2127-2136 [Full Text]  
• Kurokawa, M., Basnet, P., Ohsugi, M., Hozumi, T., Kadota, S., Namba, T., Kawana, T., Shiraki, K. (1999). Anti-Herpes Simplex Virus Activity of Moronic Acid Purified from Rhus javanica In Vitro and In Vivo. J. Pharmacol. Exp. Ther. 289: 72-78 [Abstract] [Full Text]  
• Kurokawa, M., Hozumi, T., Basnet, P., Nakano, M., Kadota, S., Namba, T., Kawana, T., Shiraki, K. (1998). Purification and Characterization of Eugeniin as an Anti-herpesvirus Compound from Geum japonicum and Syzygium aromaticum. J. Pharmacol. Exp. Ther. 284: 728-735 [Abstract] [Full Text]