Topical cidofovir compounding cream for the treatment of disseminated infection by molluscum contagiosum

Caso presentado por: Ana Capela, Carla Sampaio, Manuela Vieira, Renata Barbosa, Susana Fraga, Teresa Soares

Localidad: Porto

Porfesión: FARMACÉUTICO

Descripción del caso clínico

A sixty-eight-year-old male patient, diagnosed with disseminated infection by molluscum contagiosum, with idiopathic acquired immunodeficiency cd4+ t-cells and pulmonary cryptococcosis treated three years ago, presented with severe erythroderma. He exhibited countless cutaneous lesions, characterized by severe pruritic millimeter papules which affected the majority of his body impairing patient’s life quality.

Tratamientos posibles y problemas relacionados con la medicación

The case was refractory to all on-label available therapies and has been prescribed topical cidofovir.

Cidofovir is a broad-spectrum antiviral agent with activity against several dna viruses. in Portugal, it has to be imported but it has European Medicines Agency’s approval to treat cytomegalovirus retinitis in specific patient conditions.

Numerous studies substantiate the prescription, which led to its approval by the referred hospital boards. cidofovir 3% cream was compoundedfrom injectable Cidofovir (vistidine®) and incorporated into commercially available fat cream (lipolium®). Due to cidofovir’s mutagenic properties and its associated risk by exposure, this preparation was performed with propper protection equipment and using luer-lock system (syringes and connectors).

Intervención farmacéutica de mejora

Offlabel therapeutic options should be reserved only for specific cases. However, as long as there are no topical options available, compounding pharmacist can be essential, providing an effective and safe formulation. operator’s safety should not be neglected, and the preparation must be carried out with appropriate precautions/protetion equipment.
Pharmaceutical intervention: 1. Bibliographic research. 2. Prescription submission for approval of ethics committee for health and clinical board of the hospital.3. Elaboration of master formula sheet performed with propper protection equipment and parameterization of labeling information. 4. Topical cidofovir preparation. 5. Patient information.

Resultados de la intervención

After three months of treatment,topical cidofovir proved to be effective, as the patient presentedwith reduced number of lesions and less evidence of pruritus. he referred no symptoms of local irritation (the most reported adverse reaction).

It should be noted that the success of this treatment required the commitment of a multidisciplinary team, with consequent improvement of patient’s life quality.

Bibliografía

1. Preparación de Medicamentos. Formulación Magistral. Volumen II. Hospital Universitario 12 de Octubre, Madrid, 2010.
2. Troncoso Mariño A, Cuiña González JR, Inaraja Bobo MT, Allegue Rodríguez F. Cidofovir tópico para el tratamento de verrugas plantares. Farm Hosp. 2010; 34(1): 48-9.
3. Arrondo Velasco A, Aránzazu Alcácera M, Del Prado ME, Letona S. Topical cidofovir for the treatment of resistant viral infections: a case report. Eur J Hosp Pharm Sci. 2009; 15(4): 83-5.
4. Toro JR, Wood LV, Patel NK, Turner ML. Topical cidofovir: a novel treatment for recalcitrant molluscum contagiosum in children infected with human immunodeficiency virus 1
5. – McElhiney LF. Topical cidofovir for treatment of resistant viral infections. Int J Pharm Compd. 2006; 10(5): 324-8.