What is the treatment for viral meningitis?

From the Guidelines

Viral meningitis treatment should primarily focus on supportive care, including rest, adequate fluid intake, and over-the-counter pain relievers, as most cases resolve on their own within 7-10 days. The treatment approach is largely based on the guidelines outlined in the UK Joint Specialist Societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults 1.

Key Considerations

• Treatment includes rest, adequate fluid intake, and over-the-counter pain relievers such as acetaminophen or ibuprofen to manage fever and headache.
• In severe cases, hospitalization may be necessary for intravenous fluids, pain management, and monitoring.
• Unlike bacterial meningitis, antibiotics are not effective against viral meningitis and should be stopped once a viral diagnosis is made 1.
• For specific viral causes, such as herpes simplex virus meningitis, antiviral medications like aciclovir or valaciclovir may be considered, but there is currently no evidence to support their use for viral meningitis treatment 1.

Special Cases

• Recurrent episodes of lymphocytic meningitis, also known as Mollaret’s meningitis, are most often caused by HSV-2, but oral valaciclovir has not been shown to reduce recurrent episodes 1.
• In cases of suspected encephalitis, such as changes in personality, behavior, or cognition, intravenous aciclovir should be given, and the British Infection Association/Association of British Neurologists guidelines on the management of encephalitis should be followed 1.

Management Approach

• Maintaining a quiet, darkened environment can help reduce headache severity, and gradually returning to normal activities as symptoms improve is recommended.
• If symptoms worsen or don't improve after several days, medical reevaluation is essential to rule out other potential causes or complications.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Viral Meningitis Treatment Overview

• Viral meningitis is an inflammation of the meninges associated with acute onset of meningeal symptoms and fever, pleocytosis of the cerebrospinal fluid, and no growth on routine bacterial culture 2.
• The viral etiology varies according to age and country, with enteroviruses accounting for 85 to 95% of all cases of aseptic meningitis 3.
• Molecular diagnostics technology has helped improve the rate of pathogen detection, reducing unnecessary antibiotic use and length of hospitalization 2, 4.

Treatment Options

• Most cases of viral meningitis have no specific treatment other than supportive care 2.
• Early administration of antiviral drugs such as acyclovir, valaciclovir, or famciclovir can shorten the duration of an episode of aseptic meningitis 5.
• Daily prophylactic administration of these medicines can also reduce the frequency of future episodes 5.
• Acyclovir has been used to treat herpes simplex virus 2 meningitis, with treatment durations ranging from 3 to 14 days 6.
• Valacyclovir has also been used to treat herpes simplex virus 2 meningitis, with treatment durations ranging from 3 to 14 days 6.

Prevention

• Many viral infections can be prevented by vaccination and proper skin protection against transmitting vectors 2.
• Enteroviruses, arboviruses, and herpes simplex virus are important etiologic agents of viral meningitis, and prevention measures should be taken to reduce the risk of infection 3.