From the Guidelines
Treatment for viral meningitis should be supportive with analgesia and fluids if necessary, as there are currently no treatments of proven benefit for most causes of viral meningitis. The primary focus is on managing symptoms while the body fights the infection. According to the UK Joint Specialist Societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults 1, some clinicians may treat herpes meningitis with aciclovir or valaciclovir, but there is no evidence to support this treatment for either HSV or VZV.
Key aspects of supportive care include:
- Providing analgesia to manage headache and fever
- Administering fluids if necessary to prevent dehydration
- Stopping antibiotics if they have been commenced, once a viral diagnosis is made
- Prioritizing expediting discharge from hospital to minimize unnecessary hospitalization
It's also important to note that if there are any suggestions of encephalitis, such as changes in personality, behavior, or cognition, or altered conscious level, intravenous aciclovir should be given for suspected HSV encephalitis, following the British Infection Association/Association of British Neurologists guidelines on the management of encephalitis, as mentioned in the guideline 1. However, for recurrent episodes of lymphocytic meningitis, also known as Mollaret’s meningitis, oral valaciclovir has not been shown to reduce recurrences in a placebo-controlled trial 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Viral Meningitis
- The treatment for viral meningitis is largely supportive, as most cases are self-limiting and have a good prognosis 2, 3.
- For cases of herpes simplex virus type 2 (HSV-2) induced meningitis, antiviral drugs such as acyclovir, valaciclovir, or famciclovir may be used to shorten the duration of an episode 4, 5.
- Daily prophylactic administration of these antiviral drugs may also reduce the frequency of future episodes of recurrent meningitis 5.
- However, it is worth noting that antiviral therapy may not always be necessary, and in some cases, it may even increase the frequency of presentation 3.
- Supportive care is often the primary treatment approach for viral meningitis, and clinician education can help manage patient expectations and reduce unnecessary antiviral usage 3.
Specific Considerations for Recurrent Meningitis
- Recurrent meningitis is less common, but most cases are caused by herpes simplex virus 2 (HSV-2) in young adults 5.
- Early administration of antiviral drugs can shorten the duration of an episode of aseptic meningitis, and daily prophylactic administration can reduce the frequency of future episodes 5.
- Mollaret's meningitis, a condition characterized by recurrent episodes of aseptic meningitis, is often self-limiting and may not require intervention or suppressive antivirals 3.
Gaps in Current Knowledge and Treatment
- Despite improvements in diagnostics, many cases of viral meningitis still remain without a proven viral etiology identified 6.
- There are no established treatments for viral meningitis, and further research is required to develop effective treatments and understand the impact of viral meningitis on long-term sequelae 6.