What is the treatment for viral (inflammation of the meninges) meningitis?

From the Guidelines

The treatment of viral meningitis is primarily supportive, focusing on alleviating symptoms and managing complications, as there are currently no treatments of proven benefit for most causes of viral meningitis 1.

Key Considerations

• Antiviral medications, such as aciclovir or valaciclovir, may be considered in cases of herpes meningitis, but there is no evidence to support their use, and potential risks should be weighed against the lack of evidence for efficacy 1.
• 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.
• Treatment should be supportive with analgesia and fluids if necessary, and antibiotics should be stopped once a viral diagnosis is made 1.
• 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 1.

Recurrent Meningitis

• Recurrent lymphocytic meningitis is most often caused by HSV-2, and episodes of meningitis can be months to years apart, but there is normally complete recovery in between episodes 1.
• Suppressive therapy with valacyclovir 500 mg twice daily is not recommended for suppression of HSV-2 meningitis, as it did not prevent recurrent episodes and may increase the risk of rebound 1.

From the FDA Drug Label

The only major urinary metabolite detected is 9-carboxymethoxymethylguanine accounting for up to 14.1% of the dose in patients with normal renal function. Herpes Simplex Encephalitis Sixty-two patients ages 6 months to 79 years with brain biopsy-proven herpes simplex encephalitis were randomized to receive either acyclovir (10 mg/kg every 8 hours) or vidarabine (15 mg/kg/day) for 10 days (28 were treated with acyclovir and 34 with vidarabine)

The treatment for viral (inflammation of the meninges) meningitis, specifically Herpes Simplex Encephalitis, is acyclovir at a dose of 10 mg/kg every 8 hours for 10 days 2.

From the Research

Treatment for Viral Meningitis

• The treatment for viral meningitis is primarily supportive care, as most viral infections have no specific treatment 3.
• However, some viral meningitis cases, such as those caused by Herpes Simplex Virus 2 (HSV-2), can be treated with antiviral medications like acyclovir, valaciclovir, or famciclovir 4, 5, 6.
• For HSV-2 meningitis, treatment with intravenous acyclovir followed by oral valacyclovir is a commonly favored approach, with a median total duration of 7 days 6.
• The dosage and duration of antiviral treatment may vary depending on the patient's condition, with some studies suggesting that a high dosage of acyclovir (up to 60 mg/kg/day) may be considered for severe cases 7.
• Immunocompromised patients may require prolonged treatment or a different antiviral regimen 6.

Antiviral Medications

• Acyclovir is an antiviral medication that can be used to treat viral meningitis, particularly HSV-2 meningitis 7, 4, 5, 6.
• Valacyclovir is another antiviral medication that can be used to treat viral meningitis, often in combination with acyclovir 4, 5, 6.
• Famciclovir is also an antiviral medication that can be used to treat viral meningitis, although it is less commonly used than acyclovir or valacyclovir 4.

Treatment Duration and Dosage

• The duration of antiviral treatment for viral meningitis can vary from 3 to 14 days, depending on the patient's condition and the specific antiviral medication used 7, 5, 6.
• The dosage of antiviral medications can also vary, with some studies suggesting that a high dosage of acyclovir (up to 60 mg/kg/day) may be necessary for severe cases 7.
• The treatment regimen may include intravenous administration of acyclovir, followed by oral valacyclovir, with the median total duration of treatment being 7 days 6.