Study of prescription-indication of antivirals for herpesviruses in a Colombian population: a cross-sectional study

BACKGROUND: to describe the utilization patterns and therapeutic indications of antivirals used for herpesvirus infections in a Colombian patient population. RESEARCH DESIGN/METHODS: a cross-sectional study on the use of antivirals for treating outpatients with herpesviruses between November 2023 and January 2024 in a Colombian population database. The Micromedex® database was used to identify Food and Drug Administration (FDA)-approved indications, off-label uses, and potentially inappropriate indications. Descriptive, bivariate, and multivariable analyses were performed. RESULTS: a total of 14,816 individuals were included (median age: 53.0 years [IQR: 35.0-65.0]; 60.5% women). Acyclovir was the most frequently prescribed antiviral (oral: 77.3%; topical: 43.4%). Overall, 56.1% received oral therapy only, 25.2% combined oral and topical therapy, and 18.7% topical therapy only. FDA-approved indications accounted for 29.1% of use (mainly treatment of herpes zoster), off-label use for 26.9% (mainly prophylaxis in immunocompromised patients), and potentially inappropriate use for 25.3% (primarily topical treatment of herpes zoster). Acyclovir use (OR: 5.93; 95% CI: 4.60-7.64) and specialist care (OR: 2.17; 95% CI: 1.73-2.71) were associated with off-label use. CONCLUSIONS: Antiviral prescribing for herpesvirus infections in a group of patients in Colombia is largely driven by acyclovir, with a substantial proportion of off-label and potentially inappropriate use, particularly involving topical therapies for herpes zoster. These findings highlight significant gaps in adherence to evidence-based recommendations and underscore the need for targeted interventions to optimize prescribing practices. One study limitation was that medications purchased out of pocket were not captured, as these purchases are not recorded in the dispensing database.