In the 2010 edition of "Current Diagnosis and Treatment," Baylor College of Medicine Professor Wayne X. Shandera, M.D. explains that the herpes simplex virus, often abbreviated as HSV, is a common cause of meningitis, especially among women who contract the genital form of the disease. The term meningitis refers to inflammation of the outer, protective covering of the spinal cord. Common symptoms include fever, headache, stiff neck and sensitivity to light. Patients who exhibit these symptoms need to see a doctor without delay.
Considerations
The National Institute of Neurological Disorders and Stroke says that treatment for meningitis depends on the patient's symptoms. Most patients, according to the Institute, present for help while their symptoms are still mild and virtually indistinguishable from flu. These patients can remain at home. Patients who exhibit difficulty staying awake, mental confusion or nausea and vomiting need to be admitted to the hospital for more aggressive care because these are later signs of the disease.
Options
In the May 2008 edition of "Current Treatment Options in Neurology," neurologist Larry E. Davis, M.D. says that patients with mild-to-moderate cases of meningitis can be treated with oral antiviral drugs such as acyclovir, valacyclovir or famciclovir. Patients who require hospitalization are initially treated with intravenous acyclovir, the only herpes simplex antiviral drug approved for intravenous administration. As symptoms improve, Davis says, they may transition to oral medications.
Dosage and Administration
According to Davis, standard oral doses for adult outpatients consist of acyclovir 400 mg every eight hours for five days, valacyclovir 1,000 mg two times per day for three to five days, or famciclovir 250 mg every eight hours for seven to 10 days. Adult inpatients receive intravenous acyclovir at a dose of 10 mg per kg body weight, every eight hours for five to seven days. Children, people with kidney problems and people taking the medications to prevent recurrences take lower doses.
Safety
In the 2008 edition of "Basic and Clinical Pharmacology," University of California-San Francisco Professor Sharon Safrin, M.D. explains that HSV antiviral drugs are generally safe and well tolerated. Up to 10 percent of patients report side effects such as headache, upset stomach and diarrhea, according to Safrin. The drug must be administered slowly--over the course of one or two hours--in patients who receive it intravenously because it has occasionally crystallized in the kidneys of dehydrated patients, causing acute kidney failure. Davis says that adequately pre-hydrating the patient and administering the drug slowly prevents this complication.
Effectiveness
Antiviral treatments stop HSV from replicating, but they do not eradicate it in cells that have already become infected. Davis says that patients treated with antiviral drugs usually start to improve within 48 to 72 hours. Complete symptom resolution often takes between two and four weeks. Some patients require low, daily doses of antiviral drugs to prevent recurrences. Examples, according to Davis, include people with HIV or other immune system problems and those who have already experienced at least one recurrence.
Supportive Care
Antiviral treatments control HSV but offer no short-term relief from symptoms such as fever or headache, which may be severe and often lasts longer than eight days, according to Davis. Davis recommends starting with over-the-counter medications such as acetaminophen and adding prescription pain medications such as morphine, meperidine or hydromorphone for patients who require them. Davis says that some patients also benefit from steroids to quell inflammation, anticonvulsants to prevent seizures and antiemetics to control vomiting, if present.
References
- "Current Medical Diagnosis and Treatment;" Stephen J. McPhee, M.D. et al.; 2010
- National Institute of Neurological Disorders and Stroke: Meningitis and Encephalitis Fact Sheet
- "Basic and Clinical Pharmacology, 11th Edition;" Bertram G. Katzung, M.D., Ph.D. et al.; 2008
- "Current Treatment Options in Neurology;" Acute and Recurrent Viral Meningitis; Larry E. Davis, M.D.; May 2008
