Treatment and Therapy for Viral Meningitis

      The most therapies for viral meningitis are supportive. Rest, rehydration, antipyretic, and anti-inflammatory or pain medication may be given if required, the most important decision is either provide initial antimicrobial therapy for bacterial meningitis in the meantime, while waiting for the main cause can be identified.
        Intravenous antibiotics should be administered early if suspected bacterial meningitis. Patients with signs and symptoms of meningoencephalitis should receive early acyclovir to prevent HSV encephalitis. Therapy can be modified as a result of the Gram stain, culture and PCR test when it becomes available. Patients in unstable condition, requiring care in the critical care unit to maintain respiratory, neurological examination, and prevention of secondary complications.

        Enteroviruses and HSV are both capable of causing septic shock loads in newborns and infants. In young patients, broad-spectrum antibiotics and acyclovir, should be given as soon as possible, when the diagnosis is suspected. Special attention should be paid to fluid and electrolyte balance (especially sodium), since SIADH (Syndrome of Inappropriate antidiuretic hormone secretion) have been reported. Fluid restriction, diuretics, and are rarely saline infusion can be used to cope with hyponatremia. Prevention of secondary infection of the urinary tract and pulmonary system is also important to be implemented

A. Surgical Treatment
No surgical treatment is usually indicated. In patients where viral meningitis is rarely complicated, such as hydrocephalus, CSF separation procedures, such as ventriculoperitoneal (VP) or LP shunting, can be done. Ventriculostomy with external collection system is indicated in rare cases of acute hydrocephalus. Sometimes mening or parenchymal biopsy for definitive diagnosis of viral infections is needed. Intracranial pressure monitoring, required for some cases of encephalitis, usually done in bed.

B. Medications
Control symptomatic with antipyretic, analgesic and anti-emetic, it is usually all that is needed in the management of viral meningitis, which do not have any complications.
The decision to begin antibacterial therapy for possible bacterial meningitis is important; empirical antibacterial therapy for the possibility of pathogens should be considered in the context of the clinical situation. Acyclovir should be used in cases with suspicion of HSV (patients with herpetic lesions), and are usually used empirically in the case of more severe complications of encephalitis or sepsis.

• Antiemetics Agent: This agent is widely used to prevent nausea and vomiting.
- Ondansetron, a selective 5-HT3 antagonists-serotonin receptors to stop in peripheral and central, Having efficacy in patients who do not respond to other anti-emetic. Adult: 4-8 mg IV every 8 hours atau12 hours. Pediatric: 0.1 mg / kg IV slow maximum 4 mg / dose; can be repeated every 12 hours.
- Droperidol: neuroleptic agent that reduces vomiting by stopping the dopamine stimulation of the chemoreceptor trigger zone. Also has a content of antipsychotic and sedative. Adult: 2.5-5 mg IV / IM every 4-6 prn. Pediatrics: 6 month: 0:05 to 00:06 mg / kg / dose,  IV / IM every 4-6 prn

• Antiviral Agents: Therapeutic anti-enteroviral still under investigation for viral meningitis and may soon be available. Regimen of anti-HIV and anti-tuberculosis is not discussed here, but should be used if infection is strongly supported clinically or confirmed by testing. Empirical therapy can be stopped when the cause of viral meningitis and bacterial meningitis has upright been removed
- Acyclovir (Zovirax): To be given as soon as the diagnosis is suspected herpetic meningoencephalitis. To inhibit the activity of both HSV-1 and HSV-2. Adult: 30 mg / kg / day, IV divided per 8 hours for 10-14 days. Pediatric: 30 mg / kg / day, IV divided per 8 hours for 10 days.

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