Encephalitis
- Infectious Diseases consult recommended.
Usual Pathogens
See Recommended Empiric Therapy in Adult Patients, Encephalitis for epidemiologic clues, investigations, and other etiologies/special considerations.
Herpes simplex virus 1
Enteroviruses
Antiviral:
| Empiric Therapy | Dose | Duration |
|---|---|---|
| ≤ 3 months old | ||
| Acyclovir | 60mg/kg/d IV div q8h | minimum 3 weeks if confirmed HSV encephalitis; stop when HSV PCR negative. If HSV PCR still positive, repeat weekly, and stop acyclovir once negative |
| > 3 months-12 years old | ||
| 30-45mg/kg/d IV div q8h | minimum 3 weeks if confirmed HSV encephalitis; stop when HSV PCR negative. If HSV PCR still positive, repeat weekly, and stop acyclovir once negative | |
| ≥ 12 years old | ||
| 30mg/kg/d IV div q8h | minimum 3 weeks if confirmed HSV encephalitis; stop when HSV PCR negative. If HSV PCR still positive, repeat weekly, and stop acyclovir once negative | |
| +/- |
Antibacterial:
If bacterial meningitis not ruled out
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Ceftriaxone | 100mg/kg/d IV div q12h | |
| + | ||
| Vancomycin | 60mg/kg/d IV div q6h | |
| +/- | ||
| Ampicillin | 300mg/kg/d IV div q6h | |
| +/- | ||
| Doxycycline | 4mg/kg/d IV/PO div q12h |