From the Guidelines
Treatment for viral meningitis should primarily focus on supportive care, as most cases resolve on their own within 7-10 days, with patients getting plenty of rest, staying hydrated, and taking over-the-counter pain relievers to reduce fever and relieve headache. The current evidence suggests that there are no treatments of proven benefit for most causes of viral meningitis 1. Some clinicians may treat herpes meningitis with aciclovir or valaciclovir, but there is no evidence to support this, and the potential risks of drug side effects and prolonged hospitalization should be weighed against the lack of evidence for efficacy 1.
In terms of management, treatment should be supportive with analgesia and fluids if necessary, and if antibiotics have been commenced, they should be stopped once a viral diagnosis is made, with priority given to expediting discharge from hospital 1. For patients with suspected encephalitis, such as those with changes in personality, behavior, or cognition, or altered conscious level, intravenous aciclovir should be given, and the British Infection Association/Association of British Neurologists guidelines on the management of encephalitis should be followed 1.
It's also important to note that some people may suffer from recurrent episodes of lymphocytic meningitis, often caused by HSV-2, but oral valaciclovir has not been shown to reduce recurrent HSV-2 meningitis in a placebo-controlled trial 1. The lack of efficacy was postulated to be due to low levels of drug in the CSF, and potentially a higher dose may give better outcomes, but no study has evaluated this as yet 1.
In specific cases where herpes simplex virus is the cause, antiviral medications like acyclovir may be prescribed, with a recommended dose of 10mg/kg IV every 8 hours for 14-21 days 1. Patients should seek immediate medical attention if symptoms worsen, including increased confusion, seizures, or difficulty walking. The supportive approach works because most viral infections causing meningitis are self-limiting, with the body's immune system eventually clearing the infection while symptomatic treatment helps manage discomfort during recovery.
Key considerations for treatment include:
- Supportive care with rest, hydration, and over-the-counter pain relievers
- Stopping antibiotics once a viral diagnosis is made
- Considering intravenous aciclovir for suspected encephalitis
- Monitoring for recurrent episodes of lymphocytic meningitis
- Seeking immediate medical attention if symptoms worsen.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment for Viral Meningitis
- The treatment for viral meningitis is largely supportive, as most viral infections have no specific treatment other than supportive care 2.
- For herpes simplex virus type 2 (HSV-2) meningitis, treatment with acyclovir has been employed, with possible beneficial effects seen 3, 4.
- The duration of treatment with intravenous acyclovir for HSV-2 meningitis can range from 3 to 14 days, with a daily dose range of 500 to 1,000 mg 4.
- Valacyclovir has also been used to treat HSV-2 meningitis, with a dose range of 500 mg once daily to 500 mg four times daily, and a median duration of treatment of 10 days following the first episode 4.
- There are no established treatments for viral meningitis, and further research is required to develop effective treatments 5.
Specific Treatment Approaches
- Acyclovir has been shown to be effective in vitro for herpes simplex virus, but has never been subjected to a clinical trial for viral meningitis 5.
- Molecular diagnostics can help improve the rate of pathogen detection, reduce unnecessary antibiotic use, and length of hospitalization 2, 5.
- Vaccination and proper skin protection against transmitting vectors can help prevent some viral infections that cause meningitis 2.