In a neonate treated with parenteral acyclovir for neonatal herpes, what is recommended if neutropenia occurs?

• A. Temporarily discontinue acyclovir until counts recover.
• B. Continue therapy regardless of ANC.
• C. Stop after 2 months.
• D. Administer more acyclovir.

Answer: (A)

When a neonate treated with IV acyclovir for neonatal herpes develops neutropenia, the safest management is to temporarily stop the drug until the neutrophil count returns to a safe level. Neutropenia raises the risk of serious bacterial infections in this vulnerable population, and stopping acyclovir allows the bone marrow to recover without the added stress of ongoing antiviral exposure. Once the neutrophil count has recovered, acyclovir can be restarted at the appropriate dose if continued HSV therapy is still indicated. Continuing the drug despite low neutrophils would heighten infection risk, and fixed-long durations or increasing the dose do not address the acute neutropenia.