title: Persistent Gaps in Appropriate Use of Empiric Acyclovir in Neonates.
abstract: The use of empiric acyclovir for suspected neonatal herpes simplex virus (HSV) infection has been debated for years. To identify the gap in the decision to initiate empiric acyclovir, we performed a retrospective chart review and administered a survey to pediatricians to assess current practices regarding evaluation for possible HSV infection. Seventy infants received empiric acyclovir over a 1-year period; of these, 3 infants (4.3%) had positive HSV testing. Fourteen infants were identified as "high-risk" for HSV infection; of these, 13 infants had incomplete testing. Survey results revealed uncertainty in the decision to initiate acyclovir and in the composition of complete diagnostic testing. This study confirmed the clinical uncertainty in the decision to initiate empiric acyclovir. Using this chart review and survey as a baseline, future efforts will focus on a quality improvement project to reduce empiric acyclovir use in low-risk infants and to ensure complete diagnostic evaluation in high-risk infants.
authors.affiliation: 1 University of North Carolina at Chapel Hill, NC, USA.
authors.forename: Peyton
authors.initials: P
authors.lastname: Wilson
authors.affiliation: 1 University of North Carolina at Chapel Hill, NC, USA.
authors.forename: Ashley G
authors.initials: AG
authors.lastname: Sutton
authors.affiliation: 1 University of North Carolina at Chapel Hill, NC, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Nassef
authors.affiliation: 1 University of North Carolina at Chapel Hill, NC, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Falato
authors.affiliation: 1 University of North Carolina at Chapel Hill, NC, USA.
authors.forename: Ravi
authors.initials: R
authors.lastname: Jhaveri
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use*; D006561:Herpes Simplex / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000188:drug therapy*; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D000212:Acyclovir
keywords: acyclovir; febrile infant; herpes simplex virus (HSV); neonate