Cidofovir 375mg/5ml solution for infusion vials

A 48-year-old man with poorly controlled HIV presented with severe human monkeypox virus (hMPXV) infection, having completed 2 weeks of tecovirimat at another hospital. He had painful, ulcerating skin lesions on most of his body and oropharyngeal cavity, with subsequent Ludwig's angina requiring repeated surgical interventions. Despite commencing a second, prolonged course of tecovirimat, he did not objectively improve, and new lesions were still noted at day 24. Discussion at the UK National Health Service England High Consequence Infectious Diseases Network recommended the use of 3% topical and then intravenous cidofovir, which was given at 5 mg/kg; the patient made a noticeable improvement after the first intravenous dose. He received further intravenous doses at 7 days and 21 days after the dose and was discharged at day 52. Cidofovir is not licensed for use in treatment of hMPXV infection. Data for cidofovir use in hMPXV are restricted to studies in animals. Four other documented cases of cidofovir use against hMPXV have been reported in the USA in 2022, but we present its first use in the UK. The scarcity of studies into the use of cidofovir in this condition clearly shows the need for robust studies to assess efficacy, optimum dosage, timing, and route of administration.

Abstract licence: Public domain

As of 29 August 2023, a total of 89,596 confirmed cases of Mpox (monkeypox) have been documented across 114 countries worldwide, with 157 reported fatalities. The Mpox outbreak that transpired in 2022 predominantly affected young men who have sex with men (MSM). While most cases exhibited a mild clinical course, individuals with compromised immune systems, particularly those living with HIV infection and possessing a CD4 count below 200 cells/mm3, experienced a more severe clinical trajectory marked by heightened morbidity and mortality. The approach to managing Mpox is primarily symptomatic and supportive. However, in instances characterized by severe or complicated manifestations, the utilization of antiviral medications becomes necessary. Despite tecovirimat’s lack of official approval by the FDA for treating Mpox in humans, a wealth of positive clinical experiences exists, pending the outcomes of ongoing clinical trials. Brincidofovir and cidofovir have also been administered in select cases due to the unavailability of tecovirimat. Within the scope of this narrative review, our objective was to delve into the clinical attributes of Mpox and explore observational studies that shed light on the utilization of these antiviral agents.

Abstract licence: CC BY

Background/Objectives: Cidofovir, an antiviral drug approved for cytomegalovirus retinitis, has emerged as an alternative treatment option for virally induced cutaneous and mucocutaneous conditions, as well as being trialed as a treatment for select neoplasms. In this review, we highlight the existing evidence, clinical uses, and rationale of using cidofovir for the treatment of cutaneous pathologies. Methods: A PubMed database literature search was conducted to identify relevant articles for inclusion in this review. Results: Cidofovir has several cutaneous applications in various formulations including intravenous, topical, and subcutaneous administrations. Primarily through case reports, case series, and retrospective reviews, cidofovir has demonstrated efficacy in treating a variety of virally induced conditions—verruca vulgaris, herpes simplex virus, molluscum contagiosum—as well as in adjuvant treatment for select neoplasms. The drug has shown efficacy in immunocompromised and immunocompetent adults and children alike. Conclusions: The body of literature supports the use of cidofovir as an effective and well-tolerated treatment for many viral cutaneous pathologies, and encourages further study for its use as an adjuvant therapy for neoplastic disease.

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Acute kidney injury (AKI) occurs commonly in hospitalized patients, especially patients in intensive care units (ICUs). Medications are among the major causative factors of AKI. This narrative review addressed and updated different aspects of anti-infective-associated AKI, including amphotericin B, cidofovir, foscarnet, polymyxins, vancomycin, and aminoglycosides. There is no standard definition or operational criteria to describe anti-infective-associated AKI. Characteristically, it usually occurs during the first two weeks of treatment and is typically dose dependent. Functional resolution occurs, but kidney injury can affect renal functional reserve and increase susceptibility to future AKI events. A variety of pathophysiological mechanisms impacting glomerular, tubular, and interstitial components of the kidney are usually responsible for the development of AKI from anti-infective medications. Oxidative stress and inflammation play a pivotal role in the pathogenesis of antibiotic-related AKI. Numerous patient-related, medication-related, and co-administered-related scenarios have been demonstrated as risk factors for anti-infective-induced AKI. Apart from traditional indexes of kidney function (serum creatinine and urine output), novel biomarkers of kidney function (e.g., serum cystatin C) and damage (e.g., urinary kidney-injury molecule-1 and neutrophil gelatinase-associated lipocalin) have been noticed in recent clinical studies with promising findings. The efficiency of preventive strategies against anti-infective-associated AKI in most cases appears to be variable, relative, and modest. Close and regular monitoring of kidney function parameters is crucial during treatment with nephrotoxic antibiotics. Currently, there is no definitive treatment modalities for the management of AKI with anti-infectives. Therefore, supportive care is the mainstay of treatment.

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Acute retinal necrosis (ARN) is a sight-threatening ophthalmic emergency that requires aggressive treatment to prevent irreversible vision loss. However, primary treatment failure (PTF), where the initial antiviral therapy is ineffective, is a common challenge in ARN management. This comprehensive review examines PTF in ARN, drawing insights from a systematic literature search spanning 1997 to 2022, which identified 35 relevant cases from 23 reports. The analysis focuses on drug resistance patterns, alternative antiviral agents, combination therapies, and emerging treatments. Potential causes of drug resistance, including host factors, viral mutations, and drug-related considerations, are elucidated. Alternative agents such as foscarnet, cidofovir, and brivudine, as well as combination approaches involving systemic and intravitreal administration, high-dose therapy, judicious use of steroids, and potential treatment-related complications, are discussed. The review also highlights emerging therapies, including vaccines, monoclonal antibodies, and natural compounds, offering insights into future directions for addressing this challenging condition.

Abstract licence: CC BY-NC-SA

Monkeypox, now known as Mpox, has reemerged as a serious public health threat due to an increasing number of outbreaks outside its primary endemic regions. Although virologically similar to smallpox, smallpox therapy is not specifically approved for Mpox. The goal of this review is to assess the pharmacological progress and therapeutic efficacy of available and new therapies for Mpox. Structured literature review methodology was used based on peer-reviewed articles, clinical trials data and global health agency reports published from 2008 to 2025. Data was collected from ClinicalTrials.gov, Scopus and WHO databases with keywords on antiviral pharmacodynamics, resistance mechanism and clinical outcome. Prominent reviewed stewards include tecovirimat, brincidofovir, and cidofovir: drugs first developed for smallpox but repositioned for Mpox under expanded access programs. Tecovirimat seems most promising, however endangered by emerging resistance mutations. Innovative strategies, including mRNA vaccines, use of nanoparticles for drug delivery and host-directed treatments, are discussed that may improve treatment efficacy and preparedness for outbreaks. The results underscore that combination regimens will be required to counter resistance, there is a need for increased access in low- and middle-income countries, and global health cooperation should be bolstered. The review endorses increased clinical trial capacities, amended regulatory approaches development of new classes of therapeutics as part of global Mpox response efforts. By combining pharmacological breakthroughs with public health readiness, global health communities can be better equipped to respond to Mpox and other possible orthopox outbreaks of the future.

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Background and Aims: Monkeypox virus (MPXV) is gaining attention in the global health community due to its potential for human transmission and similarities to the well-known smallpox virus. Mpox was first detected in the 1970s and mostly affects Central and West Africa. However, it has caused rare outbreaks in isolated regions worldwide, indicating a possible global health impact. Methodology: In this review, we will look at several elements of mpox, such as its epidemiological patterns, clinical symptoms in infected individuals, and contemporary diagnostic and preventative techniques. A large portion of this review is also devoted to assessing the efficacy and safety of investigational antiviral medicines like cidofovir and brincidofovir. These assessments are based on controlled experiments conducted in laboratory settings and investigations on animal models. Results: So far, the medical profession lacks antiviral drugs, particularly intended to combat mpox. However, research has yielded promising outcomes in the usage of investigational medications such as cidofovir and brincidofovir. In the absence of targeted antiviral therapies, mpox is primarily managed by supportive care. This involves attempts to alleviate symptoms, keep hydration and electrolyte balance, and adopt effective infection control techniques. Conclusion: This review provides an informative and thorough examination of mpox, emphasizing its importance and possible hazards in both public health and therapeutic settings. The lack of specialized antiviral therapies for mpox is a huge gap in our medical arsenal. However, continuous research into new medications provides a glimpse of optimism.

Abstract licence: CC BY