From the Guidelines
Treatment for aseptic meningitis is primarily supportive care, focusing on hydration, rest, and pain management, as most cases are caused by viruses that resolve on their own without specific antiviral therapy. The mainstay of treatment includes adequate hydration, with a goal of at least 2-3 liters of fluid intake daily unless contraindicated, and pain management with over-the-counter medications like acetaminophen (500-1000 mg every 6 hours, not exceeding 4000 mg daily) or ibuprofen (400-600 mg every 6-8 hours with food) to relieve headache and fever 1.
Key Considerations
- Severe cases may require hospitalization for intravenous fluids, pain control, and monitoring.
- Anticonvulsants may be necessary if seizures occur.
- It's crucial to avoid unnecessary antibiotics since they are ineffective against viral causes and can contribute to antibiotic resistance.
- Recovery typically occurs within 7-10 days, though some symptoms like fatigue may persist longer.
- Patients should seek immediate medical attention if they experience worsening symptoms such as altered mental status, persistent vomiting, seizures, or increasing neurological deficits, as these may indicate complications or a different diagnosis requiring alternative treatment.
Specific Antiviral Therapy
For cases of HSV-2 meningitis, acyclovir 10 mg/kg intravenously every 8 hours until resolution of fever and headache, followed by valacyclovir 1 g three times daily to complete a 14-day course, is suggested 1. However, for recurrent HSV-2 meningitis, suppressive therapy with valacyclovir 500 mg twice daily is not recommended due to insufficient central nervous system penetration and the risk of rebound upon discontinuation 1.
General Management
- Supportive care is the cornerstone of treatment, with a focus on managing symptoms and preventing complications.
- Regular monitoring of the patient's condition is essential to promptly identify any worsening of symptoms or development of complications.
- Education on the disease, its management, and when to seek medical help is crucial for patient care and safety.
From the Research
Treatment for Aseptic Meningitis
- The treatment for aseptic meningitis is mainly supportive, except for non-viral infectious etiology 2.
- Supportive care is often the only treatment required for aseptic meningitis, which is typically a benign childhood infection 3.
- Most cases of aseptic meningitis are viral and require supportive care, with a good prognosis 4.
- Treatment should focus on relieving symptoms such as headache, fever, and malaise, and may include pain management and hydration.
- In some cases, treatment may involve addressing the underlying cause of the aseptic meningitis, such as discontinuing a medication that may be causing the condition 5, 6.
Specific Treatment Approaches
- For viral aseptic meningitis, treatment is usually focused on relieving symptoms and supporting the patient's overall health 2, 4.
- For drug-induced aseptic meningitis, treatment may involve discontinuing the offending medication and providing supportive care 5, 6.
- For aseptic meningitis caused by systemic diseases or neoplastic conditions, treatment may involve addressing the underlying condition and providing supportive care 5.