{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T19:37:46Z","timestamp":1783366666034,"version":"3.54.6"},"reference-count":13,"publisher":"American Academy of Pediatrics (AAP)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,7,1]]},"abstract":"<jats:p>Optimal acyclovir dosing under continuous renal replacement therapy (CRRT) in neonates is unknown. We monitored serum acyclovir levels and herpes simplex virus 1 (HSV-1) DNA levels in a neonate with disseminated HSV-1 infection and renal failure undergoing CRRT. A full-term, 5-day-old female presented with a 2-day history of lethargy and fever. She developed fulminant hepatitis and was diagnosed with HSV-1 infection by real-time polymerase chain reaction. Acyclovir was initiated at 60 mg\/kg\/day, which was lowered to 20 mg\/kg\/day because of development of renal failure. She was placed on continuous hemodialysis. Acyclovir dosing was adjusted according to serum acyclovir levels, and HSV-1 viral load was sequentially monitored. Semiquantification of serum HSV-1 levels was performed by real-time polymerase chain reaction. Acyclovir levels were measured by using liquid chromatography-tandem mass spectrometry. Acyclovir was administered at 20 mg\/kg intravenously over 1 hour; peak concentration was 18.9 \u03bcg\/mL. The half-life of acyclovir was estimated to be 2 to 3 h. Viral load remained high during dosing every 24 hours, with a decline of 0.17 log copies\/24 hours. Acyclovir dosing was changed to 20 mg\/kg\/dose every 8 hours, with an average viral load decline of 0.44 log copies\/24 hours. Despite the guideline recommendation of 24-hour redosing, acyclovir was dialyzed at a rate that resulted in suboptimal treatment. Individual therapeutic drug monitoring for acyclovir and dosing adjustment may be required to optimize therapy for patients undergoing CRRT.<\/jats:p>","DOI":"10.1542\/peds.2014-3380","type":"journal-article","created":{"date-parts":[[2015,6,23]],"date-time":"2015-06-23T00:20:39Z","timestamp":1435018839000},"page":"e270-e274","source":"Crossref","is-referenced-by-count":9,"title":["Therapeutic Drug Monitoring in Neonatal HSV Infection on Continuous Renal Replacement Therapy"],"prefix":"10.1542","volume":"136","author":[{"given":"Takanori","family":"Funaki","sequence":"first","affiliation":[{"name":"Divisions of Infectious Diseases, Department of Medical Subspecialties,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ippei","family":"Miyata","sequence":"additional","affiliation":[{"name":"Divisions of Infectious Diseases, Department of Medical Subspecialties,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kensuke","family":"Shoji","sequence":"additional","affiliation":[{"name":"Divisions of Infectious Diseases, Department of Medical Subspecialties,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Enomoto","sequence":"additional","affiliation":[{"name":"Acute and Critical Care, Department of Anesthesia and Intensive Care, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seisuke","family":"Sakamoto","sequence":"additional","affiliation":[{"name":"Transplant Surgery, Transplant Center, National Center for Child Health and Development, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mureo","family":"Kasahara","sequence":"additional","affiliation":[{"name":"Transplant Surgery, Transplant Center, National Center for Child Health and Development, Tokyo, 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