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Encephalitis Medication
Author: David S Howes, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP more...
Updated: Apr 13, 2016
Medication Summary
The goals of pharmacotherapy are to reduce morbidity and prevent complications.
Antivirals are used to manage treatable viral encephalitides. Corticosteroids may be
considered for postinfectious or noninfectious encephalitis.
Antivirals
Class Summary
The goal of the use of antivirals for herpes simplex encephalitis (HSE) and varicella
zoster encephalitis is to shorten the clinical course, prevent complications, prevent
the development of latency and/or subsequent recurrences, decrease transmission,
and eliminate established latency.
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Acyclovir (Zovirax)
Acyclovir has demonstrated inhibitory activity directed against both herpes simplex
virus type 1 (HSV1) and HSV2, and infected cells selectively take it up.
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Foscarnet (Foscavir)
Foscarnet is an organic analogue of inorganic pyrophosphate. It inhibits replication
of known herpes viruses, including cytomegalovirus, CMV, HSV1, and HSV2. It
exerts antiviral activity by inhibiting viral replication at pyrophosphatebinding sites
on virusspecific DNA polymerases at concentrations that do not affect cellular DNA
polymerases.
Patients who have poor clinical response or experience persistent viral excretion
during therapy, especially HIVpositive patients, may be resistant to acyclovir.
Patients who tolerate foscarnet may benefit from maintenancelevel administration
of 120 mg/kg/d early in treatment. Dosing should be individualized on the basis of
the patient's renal function.
Corticosteroids
Class Summary
Corticosteroids are antiinflammatory agents used for treatment of postinfectious
encephalitis and acute disseminated encephalitis. These drugs are commonly
presented as treatment alternatives, though supporting data are limited.
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Dexamethasone
Dexamethasone is used to treat various allergic and inflammatory diseases. It may
decrease inflammation by suppressing migration of polymorphonuclear leukocytes
and reversing increased capillary permeability.
Diuretics
Class Summary
These agents are used in patients with hydrocephalus and increased intracranial
pressure (ICP) when more aggressive diuresis is desired.
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Furosemide (Lasix)
Furosemide is a loop diuretic that increases excretion of water by interfering with
the chloridebinding cotransport system, which, in turn, inhibits sodium and chloride
reabsorption in the ascending loop of Henle and distal renal tubule. It increases
renal blood flow without increasing the filtration rate. The onset of action generally
is within 1 hour. It increases potassium, sodium, calcium, and magnesium
excretion.
The proposed mechanism for furosemide in lowering intracranial pressure include
(1) lowering cerebral sodium uptake, (2) affecting water transport into astroglial cells
by inhibiting the cellular membrane cationchloride pump, and (3) decreasing
cerebrospinal fluid production by inhibiting carbonic anhydrase.
The dose must be individualized to the patient. Depending on the response,
administer at increments of 2040 mg, no sooner than 68 hours after the previous
dose, until desired diuresis occurs. When treating infants, titrate with 1mg/kg/dose
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6/13/2016 Encephalitis Medication: Antivirals, Corticosteroids, Diuretics, Benzodiazepines
increments until a satisfactory effect is achieved.
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Mannitol (Osmitrol)
Mannitol may reduce pressure in the subarachnoid space by creating an osmotic
gradient between cerebrospinal fluid in the arachnoid space and plasma. This agent
is not intended for longterm use.
Initially assess for adequate renal function in adults by administering a test dose of
200 mg/kg, given IV over 35 minutes. This should produce a urine flow of at least
3050 ml/h of urine over 23 hours.
In children, assess for adequate renal function by administering a test dose of 200
mg/kg, given IV over 35 minutes. This should produce a urine flow of at least 1
mL/kg over 13 hours.
Benzodiazepines
Class Summary
These agents are used to treat seizures associated with encephalitis.
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Lorazepam (Ativan)
Lorazepam is a sedative hypnotic with a short onset of effects and relatively long
halflife.
By increasing the action of gammaaminobutyric acid (GABA), which is a major
inhibitory neurotransmitter in the brain, lorazepam may depress all levels of the
CNS, including limbic and reticular formation.
It is important to monitor the patient's blood pressure after administering a dose.
Adjust the dose as necessary.
Contributor Information and Disclosures
Author
David S Howes, MD Professor of Medicine and Pediatrics, Residency Program Director Emeritus, Section of
Emergency Medicine, University of Chicago, University of Chicago, The Pritzker School of Medicine
David S Howes, MD is a member of the following medical societies: American Academy of Emergency Medicine,
American College of Emergency Physicians, Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
Coauthor(s)
Marjorie Lazoff, MD EditorinChief, Medical Computing Review
Marjorie Lazoff, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical
Informatics Association, American College of Emergency Physicians, Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
Chief Editor
Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program
Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University
School of Medicine
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha,
American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of
Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine, American Academy of
Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians,
American College of Physicians
Disclosure: Nothing to disclose.
Acknowledgements
Steven A Conrad, MD, PhD Chief, Department of Emergency Medicine; Chief, Multidisciplinary Critical Care
Service, Professor, Department of Emergency and Internal Medicine, Louisiana State University Health Sciences
Center
Steven A Conrad, MD, PhD is a member of the following medical societies: American College of Chest
Physicians, American College of Critical Care Medicine, American College of Emergency Physicians, American
College of Physicians, International Society for Heart and Lung Transplantation, Louisiana State Medical
Society, Shock Society, Society for Academic Emergency Medicine, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.
Robin R Hemphill, MD, MPH Associate Professor, Director, Quality and Safety, Department of Emergency
Medicine, Emory University School of Medicine
Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency
Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
J Stephen Huff, MD Associate Professor of Emergency Medicine and Neurology, Department of Emergency
Medicine, University of Virginia School of Medicine
J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine,
American Academy of Neurology, American College of Emergency Physicians, and Society for Academic
Emergency Medicine
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6/13/2016 Encephalitis Medication: Antivirals, Corticosteroids, Diuretics, Benzodiazepines
Disclosure: Nothing to disclose.
Todd Pritz, MD Intensivist, St Anthony's Medical Center and St John's Mercy Medical Center
Todd Pritz, MD is a member of the following medical societies: Massachusetts Medical Society and Society of
Critical Care Medicine
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD, Adjunct Assistant Professor, University of Nebraska Medical Center College
of Pharmacy; EditorinChief, Medscape Drug Reference
Disclosure: Medscape Reference Salary Employment
References
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