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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
31

Dermatopharmacokinetics : an approach to evaluate topical drug bioavailability

Russell, Lisa Maria January 2008 (has links)
Skin, more specifically the outermost skin layer, the stratum corneum (SC), forms an extremely effective barrier, preventing both the loss of heat and water, and the ingress of micro-organisms and chemicals. Assessing the rate and extent of drug permeation into or through the skin is important both to evaluate the usefulness of a drug for topical or transdermal delivery, and to compare different formulations to assess their bioequivalence. Prediction of drug permeation is logistically, ethically and economically preferable to in vivo measurements. The recent progress that has been made with empirical and mechanistic mathematical models, along with in vitro diffusion cell techniques has been reviewed. However, currently, in vivo measurements, in man, are still required. For new chemical entities, the need for clinical trials is clear. In the case of generic products, however, there is considerable effort currently being expended to replace expensive, subjective clinical trials with objective, validated measurements of drug permeation, in vivo, in particular to assess bioequivalence. The tape stripping technique has emerged as a promising technique to objectively measure drug permeation through skin, and is the focus of this thesis. After formulation application and removal, layers of SC are sequentially removed by adhesive tapes. As the SC performs the main barrier function of the skin, measuring the rate and extent of drug permeation through this layer is assumed to be related to overall topical bioavailability. The work in this thesis concentrates on performing tape stripping studies such that all tapes are analysed individually, and drug concentration as a function of SC depth is measured. The concentration depth profiles across the SC may be fitted to an appropriate solution of Fick's second law of diffusion to obtain estimates of the vehicle-SC partition coefficient and the drug's diffusivity in the membrane. These dermato-pharmacokinetic parameters may be compared for different formulations.
32

Padronização de novo método ex vivo para avaliação da permeabilidade intestinal de fármacos utilizando epitélio intestinal de rã-touro (Rana catesbeiana): comparação com células Caco-2 / Standardization of new ex vivo method to assess intestinal permeability of drugs using intestinal epithelium of bullfrog (Rana catesbeiana): comparison with Caco-2 cells

Paula Cristina Torres de Souza 07 August 2014 (has links)
Métodos in vitro utilizando epitélio intestinal animal são importantes ferramentas para avaliar a permeabilidade de fármacos, propriedade que é um importante parâmetro de biodiosponibilidade. Considerando que o maior objetivo na indústria farmacêutica é desenvolver novos fármacos com boa biodisponibilidade oral, o projeto teve como objetivo padronizar o modelo de permeação com membrana de intestino de rã (Rana catesbeiana) em células de Franz, comparando seus resultados com ensaios de células Caco-2. Os fármacos modelo utilizados foram os antivirais zidovudina e aciclovir. A quantidade de fármaco permeado foi determinada por método de eletroforese capilar para o método com intestino de rã touro e por HPLC-UV para os ensaios com células Caco-2. O parâmetro de permeação foi o coeficiente de permeabilidade aparente (Papp) dos fármacos para ambos modelos experimentais. Para estabelecimento do protocolo experimental dos estudos de permeabilidade intestinal de rã, foi proposto um projeto fracionado 24-1 com 4 ensaios adicionais usando o software Minitab, e as variáveis foram: secção intestinal, pH da solução de Ringer e temperatura. A análise do planejamento experimental feita pela estimativa dos parâmetros da regressão obtidos através dos resultados do modelo fatorial possibilitou a determinação dos coeficientes da equação matemática que definiu a influência das variáveis sobre o coeficiente de permeabilidade aparente dos fármacos. Os efeitos das variáveis pH e temperatura interpretados conjuntamente apresentaram interferência leve, porém as variáveis fármaco e secção intestinal interpretados juntos tiveram interferência importante, mostrando maior permeação dos fármacos através da secção inicial do intestino da rã. Os resultados de Papp foram: para o metoprolol, pelo método das células Caco-2 foi de 28 x 10-6 cm/s, valor que está de acordo com demais dados de células Caco-2 na literatura e o valor obtido com células de Franz que mais se adequada a estes resultados e demais disponíveis provenientes de outras técnicas na literatura, foi de 28,1 x 10-6 cm/s, em uma das condições do planejamento estatístico utilizando segmento final da membrana epitelial da rã. No caso do aciclovir, o resultado de Papp de 0,48 x 10-6 cm/s também obtido em uma das condições envolvendo segmento intestinal final da rã foi exatamente igual a o valor 0,48 x 10 - 6 cm/s, encontrado com células Caco-2 no presente estudo e estão de acordo com outros valores disponíveis na literatura por Trapani e colaboradores, 2004 e também com células Caco-2. Para zidovudina o valor de Papp obtido em uma das condições utilizando segmento intestinal inicial da rã, de 13 x 10-6 cm/s, foi a que mais se assemelhou ao obtido pela técnica de células Caco-2, 13,6 x 10-6 cm/s, e também está de acordo com demais dados da literatura. / There are lots of different in vitro technics in the literature using animal intestinal epithelium to estimate permeability of drugs, property that is an important parameter of bioavailabity. Considering that the main objective of Pharmaceutical Companies is the development of new drugs with good oral bioavailabity, the aim of this work was to standardize the permeability of antivirals using in vitro/ex vivo method of intestinal epithelium of Rana catesbeiana in Franz cells and compare these results to those obtained from studies using Caco-2 cells. Zidovudine and Acyclovir were selected as model drugs. The amount of drug permeated will be determined by the method of capillary electrophoresis for assays using Rana Catesbeiana and HPLC-UV for studies with Caco-2 cells. The permeation parameter determined was the apparent permeability coefficient (Papp) of drugs for both experimental models. To establish the experimental protocol to studies of intestinal permeability of frog, it was proposed a fractional 24-1 design with 4 additional tests using Minitab software and the variables were: intestinal section, pH of Ringer solution and temperature. The analysis of the experimental design made by the estimate of the regression parameters obtained from the factorial model results allowed the determination of the coefficients of the mathematical equation that defines the influence of the variables on the apparent permeability coefficient of acyclovir and zidovudine. The effects of pH and temperature interpreted jointly presented a slight interference, but the variables drug and intes tinal section interpreted together had major interference, showing greater permeation of drugs through the initial section of the intestine of the frog . The results of Papp were: for metoprolol, with the method of Caco-2 cells was 28 x 10-6 cm/s, a value which is consistent with other data of Caco-2 cells provided in the literature and the condition obtained with Franz cells that are most suitable for these and other results obtained from other techniques available in the literature, was 28.1 x 10-6 cm/s, provided with the final intestinal segment using frog epithelial membrane. In the case of acyclovir, the result of Papp of 0.48 x 10-6 cm/s obtained in one condition with final frog intestinal segment was exactly equal to the value of 0.48 x 10-6 cm/s, found with Caco-2 cells in the present study and are in agreement with other values available in the literature for Trapani and colegues, 2004 and also with Caco-2 cells. The Papp value for zidovudine obtained with the initial gut segment of frog, 13 x 10-6 cm /s was which more resembled that obtained by the technique of Caco-2 cells, 13.6 x 10-6 cm/s and is also consistent with other literature data.
33

Využití tuhých elektrod na bázi uhlíku k elektrochemické oxidaci acikloviru / Utilization of carbon-based solid electrodes to electrochemical oxidation of acyclovir

Vaněčková, Eva January 2014 (has links)
Electrochemical oxidation of acyclovir at glassy-carbone electrode and boron-doped diamond electrode gives one pH-dependent oxidation signal; the corresponding electrode reaction is controlled by diffusion. It is followed by a second indistinctive signal in the pH range 2,0 - 9,0. Further, optimization of conditions was carried out for determination of acyclovir using DC and DP voltammetry. The calibration dependence on GC electrode in B−R buffer (pH = 6,0) is linear only in the concentration range from 2 to 10 μmol∙l−1 for DCV with limit of detection 0,38 μmol∙l−1; for DPV it is not linear. BDD electrode has to be activated to prevent its passivation. Anodic activation at +2,4 V for 15 s with simultaneous stirring of solution results in relative standard deviation of 0,9% for acyclovir concentration of 1∙10−4 mol∙l−1. Using DCV and DPV methods linear concentration dependences were obtained in 0,1 mol∙l-1 nitric acid and in pH 6,0 B−R buffer. The lowest limit of detection and limit of quantification (LOD = 0,47 μmol∙l−1 a LOQ = 1,55 μmol∙l−1) and linear range from 0,6 to 100 μmol∙l−1 was reached in pH 6,0 B−R buffer. Further, standard addition method was used to quantify acyclovir in Zovirax tablets. Satisfactory recoveries of 101,1 ± 2,3 % using DCV and 98,8 ± 2,2 % using DPV at BDD (compared with the...
34

HERPESVÍRUS BOVINO TIPOS 1, 2 E 5: SENSIBILIDADE A ANTIVIRAIS IN VITRO, PATOGENIA E TERAPÊUTICA EXPERIMENTAL EM COELHOS / BOVINE HERPESVIRUSES 1, 2 AND 5: SENSITIVITY TO ANTIVIRALS IN VITRO, PATHOGENESIS AND EXPERIMENTAL THERAPY IN RABBITS

Dezengrini, Renata 16 December 2009 (has links)
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Aspects of bovine herpesvirus 5 (BoHV-5) pathogenesis and experimental therapies against BoHV-1 and BoHV-5 were investigated in vitro and in inoculated rabbits. In chapter 1, we investigated the role of nitric oxide (NO), a component of innate immunity against pathogens, in the neurological disease by BoHV-5 in rabbits. Spectrophotometry for NO products revealed that NO levels were significantly increased in several regions of the brain of rabbits with neurological disease [F(4, 40)=3.33; P<0.02]. Quantification of NO levels in the brain at different time points after virus inoculation revealed a gradual increase [F(12, 128)=2.82; P<0,003], correlated spatially and temporally with virus dissemination within the brain and preceding the development of neurological signs. Thus, we propose that the overproduction of NO in the brain of BoHV-5-infected rabbits may participate in the pathogenesis of neurological disease. In chapter 2, the activity of three anti-herpetic drugs was tested against BoHV-1, BoHV-2 and BoHV-5 in vitro by plaque reduction assay. Acyclovir was moderately active against the three viruses; Gancyclovir was moderately effective against BoHV-2, and to a lesser extent against BoHV-5, being poorly active against BoHV-1. Foscarnet (PFA) exhibited the most pronounced antiviral activity, being the only drug that, at the concentration of 100 ìg/mL, completely inhibited plaque formation by all three viruses. In chapter 3, we report the activity of PFA in rabbits inoculated with BoHV-1 or BoHV-5. Rabbits inoculated with BoHV-5 and treated with 100 mg/kg of PFA presented mortality rates (11/22 or 50%) statistically lower than non-treated controls (21/22 ou 95.4%) (P<0.0008). A significant reduction in the mean virus titers was observed at day 3 pi, the peak of virus shedding [F(9,108) = 2,23; P<0.03]. Reduction in virus shedding, frequency, severity and duration of ocular signs were also observed in rabbits inoculated with BoHV-1 into the conjunctival sac, comparing to the controls. The prolonged incubation period and the reduction in the duration of the clinical course of the PFA-treated group was significant (P<0.005 and P<0.04, respectively). Therefore, the activity of PFA in vivo against BoHV-1 and BoHV-5 may be exploited in further experimental therapies. In chapter 4, we investigated the effect of the inhibition of the inducible isoform of nitric oxide synthase (iNOS), associated or not with PFA treatment, on neurological infection by BoHV-5 in rabbits. Groups of BoHV-5-inoculated rabbits were treated with the iNOS inhibitor aminoguanidine (AG); with PFA; with both drugs; or maintained as virus controls. Morbidity and mortality rates were 100% (6/6) in the groups AG and CV, 66.7% (4/6) in the group PFA and 83.3% (5/6) in the group AG+PFA. The incubation period was significantly lower (P<0.05) and the onset of neurological disease occurred earlier and was more severe in the group AG. These results demonstrate that treatment with PFA reduced morbidity and mortality rates associated to BoHV-5 infection, that AG treatment anticipated the development of neurological signs, and that the development of neurolocial disease was delayed in the group treated with both drugs. Taken together, these results contribute to the knowledge of the pathogenesis of BoHV-5 neurological disease and pave the way for other experimental pathogenesis and therapy studies. / Aspectos da patogenia da infecção neurológica pelo herpesvírus bovino 5 (BoHV-5) e terapias experimentais contra o BoHV-1 e BoHV-5 foram estudados in vitro e em coelhos inoculados. O capítulo 1 relata a investigação do papel do óxido nítrico (NO), um componente da imunidade inata contra patógenos, na doença neurológica produzida pelo BoHV-5 em coelhos. Espectrofotometria para os produtos de degradação do NO revelou um aumento significativo nos seus níveis em várias regiões do encéfalo de coelhos infectados (F(4, 40)=3.33; P<0,02). A quantificação do NO no encéfalo nos dias seguintes à inoculação viral revelou um aumento gradativo (F(12, 128)=2.82; P<0,003), correlacionado temporal e espacialmente com a invasão e disseminação viral, e precedendo o desenvolvimento de sinais neurológicos. Sugere-se, assim, que a produção aumentada de NO em resposta à infecção possa participar da patogenia dessa doença neurológica. No capítulo 2, investigou-se a atividade de três fármacos antivirais frente ao BoHV-1, BoHV-2 e BoHV-5 in vitro pelo teste de redução do número de placas. O Aciclovir foi moderadamente ativo frente aos três vírus; o Ganciclovir apresentou atividade moderada frente ao BoHV-2 e, em menor grau, contra o BoHV-5, sendo ineficaz frente ao BoHV-1. O Foscarnet (PFA) apresentou a atividade antiviral mais pronunciada, sendo o único fármaco que, na concentração de 100 μg/mL, inibiu completamente a produção de placas pelos três herpesvírus bovinos. No capítulo 3, investigou-se a atividade do PFA em coelhos inoculados com o BoHV-1 ou BoHV-5. Coelhos inoculados com o BoHV-5 e tratados com 100 mg/kg do PFA apresentaram índices de mortalidade (11/22; 50%) estatisticamente inferiores aos controles não-tratados (21/22; 93,7%) (P<0,0008). Uma redução significativa no título médio de vírus foi observada no dia 3 pi, pico da excreção viral [F(9,108) = 2,23; P<0,03]. Em coelhos inoculados no saco conjuntival com o BoHV-1 e tratados com o PFA, foram observadas reduções na excreção viral, na frequência, severidade comparando-se com o grupo controle. O período de incubação prolongado e a redução na duração do curso clínico no grupo tratado foi significante (P<0,005 e P<0,04, respectivamente). A atividade antiviral do PFA in vivo contra o BoHV-1 e BoHV-5 abre a perspectiva para outras terapias experimentais. No capítulo 4, investigou-se o efeito da inibição da isoforma induzível da enzima óxido nítrico sintase (iNOS), associada ou não ao tratamento com o PFA, na infecção neurológica pelo BoHV-5 em coelhos. Grupos de coelhos inoculados com o BoHV-5 foram tratados com o inibidor da iNOS aminoguanidina (AG); com PFA; com ambos os fármacos; ou não receberam tratamento. Os índices de morbidade e mortalidade foram de 100% (6/6) nos grupos AG e controle; 66,7% (4/6) no grupo PFA e 83,3% (5/6) no grupo AG+PFA. O período de incubação foi significativamente menor (P<0,05) e os sinais neurológicos foram mais precoces e severos nos animais do grupo AG. Portanto, o tratamento com PFA reduziu a morbidade e mortalidade associadas com a infecção pelo BoHV-5; o tratamento com AG resultou no agravamento e na antecipação do quadro neurológico e no grupo tratado com ambos os fármacos observou-se um desenvolvimento mais tardio dos sinais neurológicos. Esses resultados contribuem para o conhecimento da patogenia da doença neurológica pelo BoHV-5 e abrem perspectivas para estudos adicionais de patogenia e terapêutica anti-herpesvírus.
35

Interaccions entre ions metàl·lics i composts d'interès biològic (halouracils i derivats sintètics, hipurats i aciclovir). Interacciones metàl·liques que desenvolupen noves molècules anticanceroses

Barceló Oliver, Miquel 27 March 2009 (has links)
La química bioinorgánica se ocupa de estudiar la función de los metales en los sistemas biológicos y de la síntesis de modelos para estudiar sistemas más complejos. Enmarcados en esta, se han estudiado los modos de interacción y los patrones de reconocimiento presentes en los complejos ternarios metal - base nitrogenada - derivado de aminoácido. En primer lugar, se han obtenido un serie de complejos binarios de 5-halouracilatos con cobre(II), zinc(II) y níquel(II) que presentan un reconocimiento por tándem de enlaces de hidrógeno entre uracilos. Con ácido orto-iodohipúrico se han preparado una serie de complejos binarios con cobalto(II), níquel(II), cobre(II), zinc(II) y plata(I). Con estos y aciclovir se ha conseguido la formación de los complejos ternarios donde los de cobalto, níquel y zinc son isoestructurales y, debido a la presencia de un apilamiento entre el aciclovir y un anillo aromático de o-iodohipúrico, se generan en la estructura los dos enantiómeros &#948; (delta minúscula) y &#955; (lambda minúscula) si consideramos los dos ligandos como un quelato gracias a la interacción por apilamiento. Con cobre(II), ácidos hipúricos y 1,10-fenantrolina o 2,2'-bipiridilo se han preparado una serie de complejos ternarios capaces de generar la especie de cobre(I) [Cu(phen)2]+ y que presentan actividad anticancerosa frente a células A549. En todos los complejos con ácidos hipúricos se ha observado que la presencia del anillo aromático perpendicular al plano amídico genera estructuras bidimensionales, mientras que con ligandos planares del mismo tipo las estructuras son tridimensionales. Finalmente se han preparado análogos de nucleótidos tipo N1-alquiluracilos y de dinucleótidos tipo N1,N1'-polimetilen-bis-uracilos. / Bioinorganic chemistry deals with the study of the role of metal ions in biologic systems and the synthesis of model compounds to study more complex systems. In line with it, we have studied the interactions modes and recognition patterns that are present in ternary complexes of the type: metal ion - nucleobase - amino acid derivative. First of all, we have obtained a series of binary compounds with 5-halouracils and copper(II), zinc(II) and nickel(II) with a recognition pattern formed by a tandem of hydrogen bonds between uracils. With orto-iodohippuric acid, we have prepared some binary complexes with cobalt(II), nickel(II), copper(II), zinc(II) and silver(I). With these binary derivatives and acyclovir we have been capable to obtain ternary complexes were, the cobalt, nickel and zinc ones are isostructural and, due to the presence of a stacking between the acyclovir and one aromatic ring of o-iodohippuric acid, they generate in the crystal structure the two enantiomers &#948; (lower case delta) and &#955; (lower case lambda) if we consider the two ligands as a chelate by means of the stacking interaction. In the case of copper, we have prepared a series of ternary derivatives with different hippuric acids and 1,10-phenanthroline and 2,2'-bipyridyl. These complexes are capable to generate the copper(I) species [Cu(phen)2]+ and they present anticancer activity against A549 cell line. An important fact in all the coordination compounds with hippuric acids is that the presence of the aromatic ring normal to the amide bond promotes the formation of bi-dimensional structures, whereas with planar ligands of the same kind we obtain tri-dimensional structures. Last but not least, we have prepared nucleotide (N1-alkiluracils) and dinucleotide (N1,N1'-polymethilen-bis-uracils) type ligands.
36

Association entre l'utilisation de la prophylaxie antivirale et la virémie du cytomégalovirus et du virus Epstein-Barr chez les receveurs pédiatriques d'une greffe de cellules souches hématopoïétiques allogéniques

Diop, Ndeye Soukeyna 08 1900 (has links)
Les infections virales en particulier celles dues aux virus de la famille des Herpesviridae pendant la période d’aplasie et de lymphopénie à la suite d’une greffe de cellules souches hématopoïétiques (GCSH) peuvent occasionner des complications très graves, souvent associées à une morbidité et mortalité élevées. Les recommandations cliniques actuelles préconisent l’utilisation des antiviraux pour la prévention de certaines de ces infections. L’efficacité du famciclovir et de l’acyclovir contre les virus de l’herpès simplex (HSV), le virus varicella-zoster (VZV) et l’herpésvirus humain de type 6 (HHV-6) est bien reconnue, cependant il nous manque des données quant à leur effet contre le virus Epstein-Barr (EBV) et le cytomégalovirus (CMV) dans la population pédiatrique. L’objectif principal de ce projet de maitrise a été de mesurer l’incidence de l’infection aux virus HSV, VZV, EBV, CMV et HHV-6 et de mesurer l’association entre l’utilisation de la prophylaxie antivirale (acyclovir et famciclovir) et l’infection (virémie asymptomatique et maladie) avec le CMV et l’EBV dans une cohorte pédiatrique de GCSH allogéniques. Les données d'une cohorte de sujets ayant subis pour la première fois une GCSH enrôlés dans quatre centres de greffes pédiatriques au Canada entre juillet 2013 et mars 2017 (Étude TREASuRE) ont été utilisées. Le recrutement a été effectué au : CHU Sainte-Justine (Montréal) (n=86), British Columbia Children’s Hospital (Vancouver) (n=31), Winnipeg Children's Hospital and CancerCare Manitoba (n=28) et Alberta Children’s Hospital (n=11). Le suivi des patients avait débuté 1 mois avant la greffe et avait duré 13 mois. L’âge médian des patients au recrutement était de 6,3 ans. Les courbes de Kaplan-Meier ont permis d’estimer l'incidence cumulée des infections CMV et EBV avec intervalle de confiance (IC) à 95% à 100 jours post-greffe en fonction de la prophylaxie antivirale (acyclovir ou famciclovir). Les modèles multivariés de régression de Cox à risques proportionnels ont permis de mesurer l'association entre la prise d’antiviraux (acyclovir ou famciclovir) et le développement de ces infections. L’étude a inclus 156 sujets âgés de 0 à 21 ans. Les incidences cumulées de la virémie des virus de HSV, VZV, EBV, CMV et HHV-6 à 100 jours de suivi ont été respectivement de 2.5% (IC 95% : 0.8–7.6), 0.8% (IC 95% : 0.1–6.1), 34.5% (IC 95% : 27.6–42.6), 19.9% (IC 95% : 14.5-27.1) et 3.4% (IC 95% : 1.2–9.1). Les incidences cumulées pour CMV et EBV n’ont pas montré de différence statistiquement significative entre les groupes ayant reçu la prophylaxie antivirale (acyclovir ou famciclovir) et ceux qui ne l’ont pas reçu. Les analyses de Cox n’ont montré aucun effet significatif des antiviraux sur le CMV avec un HR ajusté de 0.55 (IC 95% : 0.24–1.26) pour l’acyclovir et de 0.82 (IC 95% : 0.30–2.29) pour le famciclovir. Il en était de même pour l’EBV avec un HR ajusté de 1.41 (IC 95% : 0.63–3.14) pour l’acyclovir et de 0.79 (IC 95% : 0.36–1.72) pour le famciclovir. Notre étude n’a montré aucune preuve d’effet de la prophylaxie antivirale avec le famciclovir et l’acyclovir contre l’EBV et le CMV. Très peu de cas de HSV et de VZV ont été diagnostiqués dans cette cohorte ce qui est conforme avec l’idée selon laquelle l’acyclovir et le famciclovir sont efficaces pour ces virus. / Viral infections, especially those involving members of the Herpesviridae during the period of aplasia and lymphopenia following allogeneic hematopoietic stem cell transplantation (HSCT), cause very serious complications, often associated with high morbidity and mortality. Current clinical guidelines recommend prophylactic use of antivirals, which has proven to be effective against certain viruses. The efficacy of famciclovir and acyclovir against herpes simplex viruses (HSV), varicella zoster virus (VZV) and human herpesvirus type 6 (HHV-6) is well-recognized, however, we lack data on their effects against Epstein-Barr virus (EBV) and cytomegalovirus (CMV) in the pediatric population. The main objective of this master's project was to measure the incidence of herpes virus infection, specifically by HSV, VZV, EBV, CMV and HHV-6, and to measure the association between the use of antiviral prophylaxis (acyclovir and famciclovir) and infection (including both asymptomatic viremia and disease) by CMV and EBV in a pediatric cohort of allogeneic HSCT. We used data from the TREASuRE cohort, which includes patients enrolled for a first allogeneic HSCT in four pediatric centers in Canada between July 2013 and March 2017. Recruitment was carried out at: CHU Sainte-Justine (Montreal) (n = 86), British Columbia Children's Hospital (Vancouver) (n = 31), Winnipeg Children's Hospital and CancerCare Manitoba (n = 28) and Alberta Children's Hospital (n = 11). Patient follow-up began 1 month before transplant and lasted 13 months. Median patient age at recruitment was 6.3 years. Kaplan-Meier curves were used to estimate the cumulative incidence of CMV and EBV infections with 95% confidence interval (CI) at 100 days post-transplant according to antiviral prophylaxis (acyclovir or famciclovir). Multivariate proportional hazards Cox regression models were used to measure the association between antiviral use (acyclovir or famciclovir) and the detection of these infections. The study included 156 subjects aged 0 to 21 years. The cumulative incidences of viremia due to HSV, VZV, EBV, CMV and HHV-6 at day 100 of follow-up were respectively 2.5% (CI 95%: 0.8–7.6), 0.8% (CI 95%: 0.1-6.1), 34.5% (CI 95%: 27.6-42.6), 19.9% (CI 95%: 14.5-27.1) and 3.4% (95% CI: 1.2-9.1). The cumulative incidences for CMV and EBV did not show a statistically significant difference between the groups who received antiviral prophylaxis (acyclovir or famciclovir) and those who did not. Cox analyses showed no significant effect of antivirals on CMV with an adjusted HR of 0.55 (95% CI: 0.24–1.26) for acyclovir and 0.82 (95% CI: 0.30–2.29) for famciclovir. The same was true for EBV with an adjusted HR of 1.41 (95% CI: 0.63–3.14) for acyclovir and 0.79 (95% CI: 0.36–1.72) for famciclovir. Our study showed no evidence of an effect with use of famciclovir or acyclovir prophylaxis on EBV and CMV infections. Very few cases of HSV and VZV infections were diagnosed in this cohort, which is consistent with the idea that acyclovir and famciclovir are effective against the latter viruses.

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