Abstract
Adenine arabinoside was evaluated for the treatment of herpes simplex encephalitis in a randomized controlled study. Of 50 patients with a presumptive clinical diagnosis and undergoing brain biopsy, 25 cases were proved by isolation of virus from the brain specimen. Adenine arabinoside treatment reduced mortality from 75 percent, 6 of 8, in placebo recipients to 29 percent, 5 of 17, in drug recipients (P = 0.027). Both groups were comparable for age, sex, race and concomitant therapy as well as the presenting signs and symptoms of the disease. Fifty percent of treated survivors were left with minor to moderate sequelae, returning home and to gainful activity. The level of consciousness at the time of biopsy and institution of therapy was the major determinant of outcome. At biopsy, the mortality rate of comatose patients was 66 percent while those lethargic or semi-comatose was 25 percent. Prognosis was not influenced by age or sex. These beneficial effects were achieved without evidence of acute drug toxicity. Thus, adenine arabinoside has a good therapeutic index (efficacy/toxicity) for the treatment of herpes simplex encephalitis. Drug must be given early in the course of infection before the advent of coma and seizures in order to attain a satisfactory outcome. Moreover, it should be coupled with brain biopsy for specific diagnosis to avoid unnecessary therapy of encephalitides which mimick herpes.
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Whitley, R., Dolin, R., Galasso, G. et al. ADENINE ARABINOSIDE THERAPY OF HERPES SIMPLEX ENCEPHALITIS: NIAID COLLABORATIVE ANTIVIRAL STUDY GROUP. Pediatr Res 11, 509 (1977). https://doi.org/10.1203/00006450-197704000-00835
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DOI: https://doi.org/10.1203/00006450-197704000-00835