The management of infants and children treated with aciclovir for suspected viral encephalitis

Arch Dis Child. 2009 May 19. [Epub ahead of print]

Kneen R, Jakka S, Mithyantha R, Riordan A, Solomon T.

Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom.

OBJECTIVE: To investigate how infants and children with suspected viral encephalitis are currently managed in a UK tertiary children's hospital. METHODS: Case note review of all infants and children who received intravenous aciclovir for suspected encephalitis over a six month period. Suspected viral encephalitis was defined as a child with fever or history of febrile illness and a reduced level of consciousness, irritability or a change in personality or behaviour or focal neurological signs. RESULTS: Fifty-one children were identified. Two had proven herpes simplex encephalitis (HSV) and two had clinically diagnosed viral encephalitis with no cause identified. Forty children had cerebrospinal fluid analysis, but basic results were incomplete in 13 cases. Cerebrospinal fluid was sent for the detection of HSV DNA by polymerase chain reaction in 27 cases. The initial dose of aciclovir was incorrect in 38 cases. The median (range) length of intravenous aciclovir treatment was 4 (1- 21) days. Six children were given a full course of aciclovir (10 or more days). For 14 children, there appeared to be no real indication for starting aciclovir. Case note documentation was generally inadequate. CONCLUSIONS: The management of children with suspected viral encephalitis appears haphazard in many cases. Guidelines for the management of children with suspected viral encephalitis are needed.