Systematic review of intralesional cidofovir dosing regimens in the treatment of recurrent respiratory papillomatosis.

OBJECTIVE: Surgical management of recurrent respiratory papillomatosis (RRP) usually involves resection via microlaryngoscopy. Intralesional injection of cidofovir has been shown to be an effective adjuvant treatment, but remains unlicensed. United Kingdom General Medical Council guidelines recommend the prescribing doctor should "be satisfied that there is a sufficient evidence base and/or experience of using the medicine to demonstrate its safety and efficacy". This study reviews the published dosing regimens of intralesional cidofovir in the treatment of RRP in order to provide a precedent for those that wish to prescribe it. METHODS: A systematic review of the literature was undertaken using Medline, EMBASE and CINAHL. Articles describing the use of intralesional cidofovir for RRP were reviewed. Information regarding cidofovir concentration, volume, total dose, number of treatments, interval between treatments, overall treatment period and follow up was extracted. RESULTS: Fifty-one articles were identified. Concentration of cidofovir injected ranged from 0.0001mg/ml to 37.5mg/ml, with 5 to 7.5mg/ml being the most common. The volume of cidofovir solution injection ranged from 0.1 to 20ml. The total dose per injection ranged from 0.15 to 105mg. There was wide variation in dosing regimens with different intervals between endoscopies, number of injections and total doses delivered. CONCLUSIONS: Based on this published literature, the precedent for prescribing intralesional cidofovir supports a concentration of 5 to 7.5mg/ml. Volumes up to 5ml per injection are routinely used. Total dose and frequency of cidofovir administration is highly variable. The need for repeat doses of cidofovir should be judged on an individual basis.

Lodged oesophageal button battery masquerading as a coin: an unusual cause of bilateral vocal cord paralysis.

An 11-month-old girl with an oesophageal foreign body was presented: from the radiographic appearance it was presumed to be a coin. Microlaryngoscopy 5 h after ingestion revealed a button battery impacted in the hypopharynx with severe damage to the oesophageal mucosa. The patient was intubated for 6 days in the intensive care unit because of stridor and respiratory distress. Repeat microlaryngoscopy demonstrated bilateral vocal cord palsy, which was presumed to be secondary to the involvement of the recurrent laryngeal nerves in the injury. We recommend that in the absence of a history of observed ingestion, it should be assumed that coin-like foreign bodies are button batteries until proven otherwise.