Viral encephalitis medical therapy: Difference between revisions
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Treatment is usually [[symptomatic]]. General considerations in treatment are: | Treatment is usually [[symptomatic]]. General considerations in treatment are: | ||
* Reliably tested specific antiviral agents are available only for a few viral agents (e.g. [[acyclovir]] for [[herpes simplex virus]] | * Reliably tested specific antiviral agents are available only for a few viral agents (e.g. [[acyclovir]] for [[herpes simplex virus]] and [[varicella-zoster]] encephalitis. Administer the first dose of [[acyclovir]] as soon as possible (in the emergency department itself). This helps in decrease in complications that may occur with delay in therapy. [[Acyclovir]] can be initiated with or without antibiotics or steroids. | ||
* Empirical treatment regimen in encephalitis is as follow: | |||
** Adult and Pediatrics encephalitis - [[Acyclovir]], 10 mg/kg body weight, q * 8h, intravenously, for 2-3 weeks. | |||
** Neonatal encephalitis - Give acyclovir 10-15 mg/kg IV q8h for neonatal HSV | |||
* Treatment for [[Toxoplasma gondii]] and [[cytomegalovirus]] encephalitis are available but are used with limited success. | * Treatment for [[Toxoplasma gondii]] and [[cytomegalovirus]] encephalitis are available but are used with limited success. | ||
* In patients who are very sick, supportive treatment, such as [[mechanical ventilation]], is equally important. | * In patients who are very sick, supportive treatment, such as [[mechanical ventilation]], is equally important. | ||
* Lab tests like blood samples should be taken before initiation of therapy. | * Lab tests like blood samples should be taken before initiation of therapy. | ||
* Neuroimaging with MRI or CT scan should be done before [[lumbar puncture]] especially if raised [[intracranial pressure]] is suspected. | * Neuroimaging with MRI or CT scan should be done before [[lumbar puncture]] especially if raised [[intracranial pressure]] is suspected. | ||
** HIV positive patients - Foscarnet is generally the treatment of choice given the high incidence of acyclovir resistance in these patients. | |||
==See also== | ==See also== | ||
Revision as of 14:58, 13 February 2012
Template:Encephalitis Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Encephalitis is an acute inflammation of the brain, commonly caused by a viral infection. Sometimes, encephalitis can result from a bacterial infection, such as bacterial meningitis, or it may be a complication of other infectious diseases like rabies (viral) or syphilis (bacterial). Certain parasitic or protozoal infestations, such as toxoplasmosis, malaria, or primary amoebic meningoencephalitis, can also cause encephalitis in people with compromised immune systems. Treatment with acyclovir with or without steroids and antibiotics should be initiated as soon as possible. Antiviral agent like acyclovir has been useful in treatment of encephalitis due to herpes simplex virus and varicella zoster. Treatment for other causative agents of encephalitis is mostly supportive.
Medical therapy
Treatment is usually symptomatic. General considerations in treatment are:
- Reliably tested specific antiviral agents are available only for a few viral agents (e.g. acyclovir for herpes simplex virus and varicella-zoster encephalitis. Administer the first dose of acyclovir as soon as possible (in the emergency department itself). This helps in decrease in complications that may occur with delay in therapy. Acyclovir can be initiated with or without antibiotics or steroids.
- Empirical treatment regimen in encephalitis is as follow:
- Adult and Pediatrics encephalitis - Acyclovir, 10 mg/kg body weight, q * 8h, intravenously, for 2-3 weeks.
- Neonatal encephalitis - Give acyclovir 10-15 mg/kg IV q8h for neonatal HSV
- Treatment for Toxoplasma gondii and cytomegalovirus encephalitis are available but are used with limited success.
- In patients who are very sick, supportive treatment, such as mechanical ventilation, is equally important.
- Lab tests like blood samples should be taken before initiation of therapy.
- Neuroimaging with MRI or CT scan should be done before lumbar puncture especially if raised intracranial pressure is suspected.
- HIV positive patients - Foscarnet is generally the treatment of choice given the high incidence of acyclovir resistance in these patients.