From the Guidelines
Treatment for viral meningitis primarily focuses on supportive care, as most cases resolve on their own within 7-10 days, and antiviral medications are only considered in specific cases where herpes simplex virus is the cause. Patients should get plenty of rest, stay hydrated, and take over-the-counter pain relievers such as acetaminophen (500-1000mg every 4-6 hours, not exceeding 4000mg daily) or ibuprofen (400-600mg every 6-8 hours with food) to manage fever and headache 1. In more severe cases, hospitalization may be necessary for intravenous fluids, pain management, and monitoring. Unlike bacterial meningitis, antibiotics are not effective against viral meningitis.
Key Considerations
- For first episode HSV-2 meningitis, acyclovir 10 mg/kg intravenously (IV) every 8 hours until resolution of fever and headache, followed by valacyclovir 1 g TID (3 times daily) to complete a 14-day course, is suggested 1.
- Among persons with established recurrent HSV-2 meningitis, oral therapy may be used for the entire course 1.
- It is essential to distinguish cases of HSV encephalitis from HSV meningitis, as HSV encephalitis is a much more severe infection with high neurologic morbidity and mortality, and should be treated with 14–21 days of IV acyclovir 1.
- Recurrent HSV-2 meningitis is a rare complication of genital HSV-2 infection, and suppressive therapy (valacyclovir 500 mg twice daily [BID]) did not prevent recurrent HSV-2 meningitis episodes 1.
Management Approach
- The supportive approach works because most viral infections causing meningitis are self-limiting, with the body's immune system eventually clearing the infection while symptom management helps patients remain comfortable during recovery.
- For immunocompromised patients or those with severe symptoms, consultation with an infectious disease specialist is recommended.
- 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, and priority given to expediting discharge from hospital 1.
From the Research
Treatment Overview
- The treatment for viral meningitis is primarily focused on supportive care, as most viral infections have no specific treatment 2.
- Management of patients is changing due to better and more rapid diagnostic tests, which can reduce the cost of workups and shorten hospitalizations 3.
Antiviral Treatment
- Early administration of antiviral drugs such as acyclovir, valaciclovir, or famciclovir can shorten the duration of an episode of aseptic meningitis, particularly in cases caused by herpes simplex virus 2 3, 4.
- Daily prophylactic administration of these medicines can also reduce the frequency of future episodes 3.
Limitations of Current Treatment
- Despite improvements in diagnostics, there are still no established treatments for viral meningitis, and the potential treatment, aciclovir, has never been subjected to a clinical trial 5.
- Many cases of viral meningitis remain without a proven viral aetiology identified, highlighting the need for further research into treatments and diagnostics 5.
Prevention
- Many of the viruses that cause viral meningitis are preventable by vaccination and proper skin protection against transmitting vectors 2.