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Cidofovir For Treatment of Adenovirus Final May 2013
Cidofovir For Treatment of Adenovirus Final May 2013
Cidofovir is a nucleoside DNA polymerase inhibitor with activity against herpes viruses,
varicellar-zoster virus, cytomegalovirus (CMV), Epstein-Barr virus, adenovirus, human
papillomavirus and human polyomavirus. It suppresses viral replication by selective
inhibition of DNA synthesis (HSV-1, HSV-2 adenovirus and CMV DNA thought to be
inhibited). Patients receiving cidofovir require pre-hydration and probenecid to minimise
nephrotoxicity.
Indications
Adenovirus
First line treatment of adenovirus infection in immunocompromised patients:
who are PCR +ve for adenovirus and active treatment is required
CMV
Second line treatment for CMV
who are PCR +ve for CMV and who have absent or non-functioning T cells, where therapies
with ganciclovir and foscarnet, or a combination of these two have failed: i.e. increasing viral
load or onset of clinical symptoms despite treatment
Preparation
• Cidofovir is prepared by the oncology pharmacy. Liaise with the paediatric pharmacist and
fax prescription to ext 5914 (Oncology pharmacy)
• Contact oncall pharmacist outside of normal pharmacy opening hours if urgent
• Available as 375mg/5ml injection for IV infusion (Section 29)
Administration
• Safe handling precautions are required when diluting and administering cidofovir
Infuse dose in 100mL sodium chloride 0.9% over one hour.
Use 50 mL of sodium chloride 0.9% if patient less than 10 kg
For fluid restricted patients cidofovir can be made as 7.5mg/mL syringes- discuss with
paediatric pharmacist
Page 1 of 2
Written and Approved by: Pharmacy Department and Paediatric Haematology and Oncology
May 2013
Guideline for Cidofovir
Hydration
• Must be given to minimise nephrotoxicity
• Hydration with sodium chloride 0.9% should be given at 15ml/kg for one hour pre and
for one hour post cidofovir
• If patient is fluid restricted in intensive care (PICU) the fluid protocol may need to be
individualized
Probenecid
Concomitant oral probenecid is thought to reduce the incidence and severity of
cidofovir related nephrotoxicity. It is thought that cidofovir becomes concentrated in
the proximal renal tubules and causes degeneration and necrosis of these cells.
Probenecid is thought to compete for uptake at the proximal tubule site thus
minimising cidofovir uptake and consequently limiting nephrotoxicity.
Probenecid Dose
3 hours pre 2 hours post end of 8 hours post end of
Weight (kg) cidofovir infusion cidofovir infusion cidofovir infusion
<20 500mg orally 250mg orally 250mg orally
21 – 40 1 gram orally 500mg orally 500mg orally
41- 60 1.5gram orally 750mg orally 750mg orally
>60 2gram orally 1gram orally 1gram orally
Reference:
Great Ormond Street Hospital. Antibiotic guidelines. 2001
Lexicomp Paediatric Dosage Handbook 17th Edition 2010
Matthes-Martin et al: Adenovirus infection in leukemia and HSCT. Transplant Infectious Disease
2012: 14: 555–563
Page 2 of 2
Written and Approved by: Pharmacy Department and Paediatric Haematology and Oncology
May 2013