title: Resolution of acyclovir-associated neurotoxicity with the aid of improved clearance estimates using a Bayesian approach: A case report and review of the literature.
abstract: OBJECTIVE
  Neurotoxicity is a side effect of acyclovir. We report the first case, to our knowledge, whereby Bayesian-informed clearance estimates supported a therapeutic intervention for acyclovir-associated neurotoxicity.
  
  
  METHODS
  A 62-year-old male with the diagnosis of disseminated zoster was being treated with intravenous (IV) acyclovir when he developed symptoms of acute neurotoxicity. Acyclovir had been dose-adjusted for renal dysfunction according to traditional creatinine clearance estimates; however, as the patient was also on vancomycin, Bayesian estimates of vancomycin clearances were performed, which revealed a 2-fold lower creatinine clearance. In response to the Bayesian estimates, acyclovir was discontinued, and improvements in mentation were noted within 24 hours.
  
  
  CONCLUSIONS
  Alternate approaches to estimate renal function beyond Cockcroft-Gault, such as a Bayesian approach used in our patient, should be considered when population estimates are likely to be inaccurate and potentially dangerous to the patient.
authors.affiliation: Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, USA.
authors.forename: W A
authors.initials: WA
authors.lastname: Watson
authors.affiliation: Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, USA.|Department of Pharmacy Practice, Midwestern University, Chicago College of Pharmacy, Downers Grove, FL, USA.
authors.forename: N J
authors.initials: NJ
authors.lastname: Rhodes
authors.affiliation: Department of Infectious Disease, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: I A
authors.identifier: http://orcid.org/0000-0002-6301-0121
authors.initials: IA
authors.lastname: Echenique
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: M P
authors.initials: MP
authors.lastname: Angarone
authors.affiliation: Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, USA.|Department of Pharmacy Practice, Midwestern University, Chicago College of Pharmacy, Downers Grove, FL, USA.
authors.forename: M H
authors.identifier: http://orcid.org/0000-0002-1091-6130
authors.initials: MH
authors.lastname: Scheetz
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage / Q000009:adverse effects*; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001499:Bayes Theorem; D003404:Creatinine / Q000032:analysis; D004305:Dose-Response Relationship, Drug; D006562:Herpes Zoster / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000175:diagnosis / Q000209:etiology*; D014640:Vancomycin / Q000008:administration & dosage / Q000493:pharmacokinetics
chemical_list: D000998:Antiviral Agents; D014640:Vancomycin; D003404:Creatinine; D000212:Acyclovir
keywords: acyclovir; adverse effects; pharmacodynamics; pharmacokinetics; statistical model