Viral Meningitis: Drug Therapy

Therapeutic target

• Avoidance of complications

Therapy recommendations

• Bacterial meningitis must be clearly excluded!
• If pronounced symptoms or systemic signs of inflammation or CSF diagnostics (with pleocytosis > 1,000/μl): blood culture (foci and pathogen diagnostics), antibiotics.
• Bland viral meningitis (with mild disease course) should be treated symptomatically antipyretic (antipyretic) and analgesic (analgesic).
• Patients with acute viral meningitis should be treated in an intensive care unit.
• Herpes simplex virus encephalitis (brain inflammation; HSV encephalitis).
  • If herpes simplex virus encephalitis is suspected, antiviral therapy (antivirals/drugs that inhibit viral replication) must be started immediately.
  • In immunocompetent patients, HSV meningitis usually improves rapidly, so that these patients need only be treated symptomatically.
  • In immunocompromised patients, aciclovir therapy (antiviral) should be performed to prevent or reduce complications or sequelae.
• Influenza virus-related CNS infections (CNS: central nervous system): neuraminidase inhibitors.
• CMV encephalitis (CMV: cytomegalovirus):foscarnet followed by administration of ganciclovir.
• Other therapeutic measures in severe encephalitides ((brain inflammation):
• • Brain edema (swelling of the brain): osmotherapeutics.
  • Pneumococcal meningitis, HSVE; increase in intracranial pressure: glucocorticoids.
  • Brain organic/epileptic seizures or status epilepticus (see epilepsy below): antiepileptic drugs.
  • Thrombosis and pulmonary embolism prophylaxis in all bedridden patients.
• See also under “Further therapy“.