Onset of Infection during Adrenocorticotropic Hormone Treatment in Infants with West Syndrome (Infantile Spasms)

Objective: To assess the prevalence and severity of infections during Adrenocorticotropic hormone treatment (ACTH ) and acess the necessity for prophylactic antibiotics during the course of treatment.

Methods: This retrospective study reviewed the medical records of children diagnosed with west syndrome between the years 2002-2018 and followed at Rambam Medical Center. Major side effects including severe infections were compared between ACTH treatment versus vigabartin treatment

Results: A total of 50 patients (30 boys, 20 girls), were enrolled. Out of 42 patients treated with ACTH, 33 (79%) showed pronounced side effects. 14 patients (28%) had severe infections during treatment that required hospitalization. 13 were treated with ACTH (31%) and one with sabril (3%). Infections included UTI, gastroenteritis, abscess, pneumonia, and upper-respiratory infections. Onset of infection from starting ACTH therapy was 25.9±10.3 days.

Side effects included: weight gain 22 (67%), hyperglycemia 12 (36%), hypertension 14 (42%), irritability 10 (30%) and hypertrophic cardiomyopathy 4 (12%). In all patients abnormal values returned back to normal at the end of ACTH treatment.

Conclusions: Our study highlights the the high risk of infections during ACTH treatment . Although the use of prophylactic medication such as antibiotics is still contrivertial there must be awareness of the risk with both parents and caregivers.