Mucosal Herpes Simplex Case Study

In a clinical situation, 14-year-old female JL received chemotherapy. She is immunocompromised with severe mucositis and malnourishment. She is diagnosed with the mucosal herpes simplex infection. According to Lexicomp and Micromedex online drug database, immunocompromised patients with mucosal herpes simplex infection should be treated with IV acyclovir sodium.1,2 It is a drug of choice for the pediatric patient to treat herpes simplex infection. According to Micromedex and manufacturer dosing information to treat any 14-year-old immunocompromised child with the presentation of herpes simplex infection, 5 mg/kg acyclovir sodium should be administered as a slow continuous infusion over 1 hour at every 8 hours for 7 days.2,3 JL is an obese patient so as per the Micromedex and manufacturer dosing, ideal body weight should be used for calculating a …show more content…
During reconstitution of a vial, use paraben free sterile water for injection. IV infusion concentration should not exceed 7 mg/ml. Rapid infusion may cause nephrotoxicity and infusion concentration beyond 7mg/ml may cause phlebitis or extravasation. Do not administer through intramuscular or subcutaneous route. After the infusion, maintain adequate hydration for first 2 hours to decrease the risk of nephrotoxicity.1-3 JL is receiving TPN for severe malnourishment. In addition to the TPN, lipids are injected. According to the Trissel IV compatibility database, acyclovir is not compatible with lipids or TPN. It causes precipitation.4 JL only has a single-lumen port for administration of the parenteral medication. She has to get TPN and IV acyclovir. IV acyclovir is not compatible therefore do not administer together. Turn off infusion pump. Stop TPN. Flush the line with 10 cc normal saline. Start IV acyclovir infusion over one hour. Flush the line again with saline and restart TPN. Repeat the procedure every 8