I read with interest the article by Roderick et al. Authors seem to
recommend post exposure prophylaxis with aciclovir from day 7 onwards for
7 days for immunocompromised patients. Whilst there is good evidence for
such use in immunocompetent subjects to enable development of effective
immunity and suppress the clinical disease, there is no good evidence for
its use in immunocompromised patients. In fact your references 17 and 18
clearly acknowledges the lack of evidence. The reference provided Fisher
JP et al(17) cross references aciclovir post exposure prophylaxis to an
article by Ishida Y, Tauchi H, Higaki A, et al. Postexposure prophylaxis
of varicella in children with leukemia by oral acyclovir. Pediatrics
1996;97:150-1. Ishida et al used post exposure aciclovir in 3 patients
within 48 hours and 2 out of them has mild symptoms. They also used normal
human immunoglobin for 2 out of the three patients which may have modified
the out come. Ishida et al recommended early use to prevent primary
viremia and severe disease.
Until we have good evidence, in similar cases when VZIG is not
available or practical, it is recommended to use aciclovir at the earliest
date post exposure rather than wait for 7 days.
I read with interest the article by Roderick et al. Authors seem to recommend post exposure prophylaxis with aciclovir from day 7 onwards for 7 days for immunocompromised patients. Whilst there is good evidence for such use in immunocompetent subjects to enable development of effective immunity and suppress the clinical disease, there is no good evidence for its use in immunocompromised patients. In fact your references 17 and 18 clearly acknowledges the lack of evidence. The reference provided Fisher JP et al(17) cross references aciclovir post exposure prophylaxis to an article by Ishida Y, Tauchi H, Higaki A, et al. Postexposure prophylaxis of varicella in children with leukemia by oral acyclovir. Pediatrics 1996;97:150-1. Ishida et al used post exposure aciclovir in 3 patients within 48 hours and 2 out of them has mild symptoms. They also used normal human immunoglobin for 2 out of the three patients which may have modified the out come. Ishida et al recommended early use to prevent primary viremia and severe disease.
Until we have good evidence, in similar cases when VZIG is not available or practical, it is recommended to use aciclovir at the earliest date post exposure rather than wait for 7 days.
Conflict of Interest:
None declared