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Viral meningitis, characterized by headache, vomiting, and positive meningeal irritation, is one of the common neurological disorders in children, and is often clinically manifested as acute onset of fever, headache, vomiting, convulsions, or impaired
consciousness.
Clinically, doctors can treat patients from the following three directions, let's take a look!
Most viruses do not have specific antiviral drugs, and treatment of mild viral meningitis with unknown etiology, such as etiology or clinical exclusion of herpes simplex virus (HSV) infection, can be discontinued, mainly symptomatic treatment
.
▍1.
Acyclovir indications:
herpes simplex virus (HSV), varicella-zoster virus (VZV) should use acyclovir
, Acyclovir is recommended
for HSV encephalitis as grade A.
Because HSV encephalitis is a common severe viral encephalitis and is a therapeutic agent with a positive effect, acyclovir should be used
first for viral encephalitis of unknown etiology or encephalitis with suspected HSV.
Drug dose and course of treatment:
for the treatment of HSV encephalitis, the recommended dose for children is 10mg/kg each time, the maximum amount of 1 time does not exceed 800mg, once every 8h, intravenous injection, lasting 14~21d
.
For neonatal HSVI encephalitis, studies have found that continued oral acyclovir for 6 months after completing 21 days of intravenous acyclovir treatment has a better
prognosis for subsequent neurodevelopment.
Acyclovir can also be used for the treatment of VZV encephalitis at the same dose as HSV encephalitis for 14 days
.
▍2, ganciclovir
indications: suitable for CMV, human herpesvirus 6
.
Drug dose and course of treatment:
for the treatment of CMV infection, 5mg/kg each time, intravenous injection, 2 times/d
.
The maintenance period is adjusted according to the individualization of treatment response and tolerability, and it is recommended to combine with sodium foscarnet during the initial induction therapy period
.
▍3, sodium
foscarnet is suitable for CMV and human herpesvirus 6
.
▍4.
Oseltamivir
is suitable for influenza viruses
.
▍5.
Interferon α
may be effective against West Nile virus and St.
Louis encephalitis virus, but not for
Japanese encephalitis.
Glucocorticoids are controversial for the treatment of most encephalitis, and there are no uniform conclusions, and studies have pointed to reduce inflammation but have not significantly improved
prognosis.
For intestinal EV71, corticosteroids are an important treatment option, with the primary goal of reducing life-threatening cerebral edema
.
Control hyperthermia, timely treatment of intracranial pressure increase (20% mannitol, 0.
5-1.
0g/kg, once every 4-6h, if necessary, diuretics, glucocorticoids, etc.
)
Maintain respiratory circulatory function (mechanical ventilation and vasoactive drugs if necessary).
Control of seizures, particularly status epilepticus (both convulsive and non-convulsive status epilepticus).
What are the diagnostic criteria for viral meningitis? What are the preferred treatments and regimens for more common diseases? What clinical signs and symptoms are prioritized for diagnosing a disease?
Open the clinical guideline module of the decision assistant App, and the dialogue with the major guidelines at home and abroad authoritative guidelines and the "clinical guidelines" module of the decision assistant have 👇
1.
Scan the QR code
below 2.
Download the Clinical Decision Assistant App 3.
Open the Decision Assistant App
and click the icon
More "Diagnosis and Treatment Guide" for Neurological Diseases can be found in the "Clinical Decision App"!
Viral meningitis, characterized by headache, vomiting, and positive meningeal irritation, is one of the common neurological disorders in children, and is often clinically manifested as acute onset of fever, headache, vomiting, convulsions, or impaired
consciousness.
Clinically, doctors can treat patients from the following three directions, let's take a look!
One
Antiviral therapy
Most viruses do not have specific antiviral drugs, and treatment of mild viral meningitis with unknown etiology, such as etiology or clinical exclusion of herpes simplex virus (HSV) infection, can be discontinued, mainly symptomatic treatment
.
▍1.
Acyclovir indications:
herpes simplex virus (HSV), varicella-zoster virus (VZV) should use acyclovir
, Acyclovir is recommended
for HSV encephalitis as grade A.
Because HSV encephalitis is a common severe viral encephalitis and is a therapeutic agent with a positive effect, acyclovir should be used
first for viral encephalitis of unknown etiology or encephalitis with suspected HSV.
Drug dose and course of treatment:
for the treatment of HSV encephalitis, the recommended dose for children is 10mg/kg each time, the maximum amount of 1 time does not exceed 800mg, once every 8h, intravenous injection, lasting 14~21d
.
For neonatal HSVI encephalitis, studies have found that continued oral acyclovir for 6 months after completing 21 days of intravenous acyclovir treatment has a better
prognosis for subsequent neurodevelopment.
Acyclovir can also be used for the treatment of VZV encephalitis at the same dose as HSV encephalitis for 14 days
.
▍2, ganciclovir
indications: suitable for CMV, human herpesvirus 6
.
Drug dose and course of treatment:
for the treatment of CMV infection, 5mg/kg each time, intravenous injection, 2 times/d
.
The maintenance period is adjusted according to the individualization of treatment response and tolerability, and it is recommended to combine with sodium foscarnet during the initial induction therapy period
.
▍3, sodium
foscarnet is suitable for CMV and human herpesvirus 6
.
▍4.
Oseltamivir
is suitable for influenza viruses
.
▍5.
Interferon α
may be effective against West Nile virus and St.
Louis encephalitis virus, but not for
Japanese encephalitis.
Two
Glucocorticoid therapy
Glucocorticoids are controversial for the treatment of most encephalitis, and there are no uniform conclusions, and studies have pointed to reduce inflammation but have not significantly improved
prognosis.
For intestinal EV71, corticosteroids are an important treatment option, with the primary goal of reducing life-threatening cerebral edema
.
Three
Symptomatic treatment
Control hyperthermia, timely treatment of intracranial pressure increase (20% mannitol, 0.
5-1.
0g/kg, once every 4-6h, if necessary, diuretics, glucocorticoids, etc.
)
Maintain respiratory circulatory function (mechanical ventilation and vasoactive drugs if necessary).
Control of seizures, particularly status epilepticus (both convulsive and non-convulsive status epilepticus).
What are the diagnostic criteria for viral meningitis? What are the preferred treatments and regimens for more common diseases? What clinical signs and symptoms are prioritized for diagnosing a disease?
Open the clinical guideline module of the decision assistant App, and the dialogue with the major guidelines at home and abroad authoritative guidelines and the "clinical guidelines" module of the decision assistant have 👇
1.
Scan the QR code
below 2.
Download the Clinical Decision Assistant App 3.
Open the Decision Assistant App
and click the icon
4.
Search for the guide you want to see
Download the app and learn a new guide every day!
Download the Decision Assistant App, the guide is free at any time~References:
[1] One of the recommendations for the treatment course of central nervous system infection and lumbar puncture examination in children—the treatment course of viral meningitis and the recommendation for lumbar puncture examination, 2020.
