Cidofovir gel

TOPICAL CIDOFOVIR FOR TREATMENT OF RESISTANT VIRAL INFECTIONS. A CASE REPORT

Arrondo, MA. Alcácera, MA. Sagredo, MP. Pardo, A. Martínez, FJ. Montis

Pharmacy Service, University Hospital Clínico Lozano Blesa, Zaragoza, Spain

Background: Cidofovir is a broad-spectrum antiviral agent, commercially available as an intravenous dosage form and approved for treatment of cytomegalovirus retinitis in HIV patients. However, numerous case reports and published studies have described successful use of topical cidofovir to treat resistant and severe forms of viral infections such as molluscum contagiosum, condylomata acuminata, genital warts, and human papillomavirus, with minimal adverse events. Topical cidofovir is compounded from the commercial parenteral solution and cream or aqueous gel base. Because of the mutagenic properties of cidofovir, compounders formulating this preparation should take cytotoxic precautions.

Methods: A 25-years old woman presented papillomatoses injuries in pubic region which were interpreted as condyloma acuminatum. After several cycles of treatment with imiquimod and podofilotoxin the injuries were refractory or reappeared and extended to the genital zone. The exudate resulted positive for papillomavirus type 6. Because of the resistance of conventional treatments and trying to avoid other more aggressive therapies like surgical resection, as much by the number of injuries like by the extension of the same ones, she was authorized to be treated with 1% cidofovir cream once daily for five consecutive days during two weeks.

Results: All the injuries disappeared completely. The only adverse effect observed was irritation in the treated zone.

Conclusions: Topical cidofovir has demonstrated effectiveness in resistant cutaneous viral infections. However, compounded cidofovir creams or gels are prohibitively expensive and should be reserved for cases in which all other conventional treatments have failed.

Reference: 13th EAHP Congress, Maastricht, the Netherlands, 27-29 February 2008