What Is the Treatment of Herpes Simplex Encephalitis?
Herpes simplex encephalitis is an acute, life-threatening viral infection of the brain caused by herpes simplex virus. It requires prompt recognition and protocol-driven treatment to improve survival and neurological outcomes.
Clinical Situation
This protocol addresses patients presenting with herpes simplex encephalitis. Patient-specific factors — including age and renal function — directly shape the treatment approach and are accounted for in the full regimen.
Treatment Approach
Management is built around intravenous antiviral therapy, with the specific agent, dosing, and duration varying according to the patient's clinical profile.
Treatment Goals
The primary endpoint is a negative CSF PCR for herpes simplex virus at the end of therapy, together with an appropriate clinical response.
References
DOI: 10.1086/589747
Herpes simplex virus: acyclovir is recommended (A-I).
Acyclovir is the treatment of choice for patients with herpes simplex encephalitis.
The dosage of acyclovir in patients with normal renal function is 10 mg/kg intravenously every 8 h for 14–21 days.
Recently, the use of higher-dose acyclovir (20 mg/kg intravenously every 8 h for 21 days) in neonates with herpes simplex encephalitis has decreased mortality to 5%, with ≈40% of survivors developing normally.
A negative CSF PCR result at the end of therapy was associated with a better outcome, suggesting that another CSF specimen should be subjected to PCR for herpes simplex virus at the end of therapy in patients who have not had the appropriate clinical response; if the result is positive, antiviral therapy should be continued.
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