From the Guidelines
Treatment for aseptic meningitis should primarily focus on supportive care, including rest, hydration, and analgesics, as most cases are caused by viral infections that resolve with the body's immune response. The goal of treatment is to manage symptoms, such as fever and headache, while the infection runs its course. According to the most recent guideline evidence 1, aseptic meningitis typically resolves spontaneously with symptomatic treatment, and CSF examination may show pleocytosis without other features of bacterial infection.
Some key points to consider in the treatment of aseptic meningitis include:
- Rest and maintaining adequate hydration to help the body recover from the infection
- Taking analgesics such as acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or ibuprofen (400-600mg every 6-8 hours with food) to manage fever and headache
- In more severe cases, hospitalization may be necessary for IV fluids, pain management, and monitoring
- Unlike bacterial meningitis, antibiotics are not effective for viral causes, though they might be started empirically until bacterial infection is ruled out
- Antivirals like acyclovir may be used if herpes simplex virus is suspected, but there is limited evidence to support its use in aseptic meningitis 1
It's also important to note that some cases of aseptic meningitis may be associated with IT administration of chemotherapeutics, and in these cases, IT corticosteroids (such as 4 mg IT dexamethasone) may be used to prevent aseptic meningitis 1. However, the use of corticosteroids should be individualized and based on the specific clinical context. Overall, the supportive approach to treatment is the cornerstone of management for aseptic meningitis, and most patients recover completely within 7-10 days without specific treatment.
From the Research
Treatment for Aseptic Meningitis
- The treatment for aseptic meningitis is typically supportive care, as most cases are viral and self-limited 2, 3, 4.
- There is no specific treatment for most viral infections that cause aseptic meningitis, other than supportive care 2.
- In some cases, aseptic meningitis can be caused by drug-induced reactions, and treatment may involve discontinuing the offending drug 5, 6.
- For cases of aseptic meningitis caused by systemic diseases, treatment may involve addressing the underlying condition 5.
- Vaccination against common pathogens that cause bacterial meningitis is recommended, and can also help prevent some cases of aseptic meningitis 2, 4.
Supportive Care
- Supportive care for aseptic meningitis may include rest, hydration, and pain management 3, 4.
- In some cases, hospitalization may be necessary to monitor the patient's condition and provide supportive care 2, 4.
Diagnosis and Differential Diagnosis
- The diagnosis of aseptic meningitis relies on the examination of cerebrospinal fluid obtained from lumbar puncture, as clinical findings can be unreliable 5, 4.
- It is important to differentiate aseptic meningitis from bacterial meningitis, as bacterial meningitis requires prompt recognition and treatment with antibiotics 4.