Table 3.
Indications and Preferred Antiviral Treatment of Herpes Simplex Virus Type Meningitis Among Respondents
| Indication | no./No. | (%) |
|---|---|---|
| What do you consider as indications for acyclovir or valacyclovir treatment of patients with confirmed HSV-2 meningitis?a | ||
| I never or only rarely treat these patients with antiviralsb | 22/223 | (10) |
| Severe symptoms | 76/223 | (34) |
| No improvement in symptoms after 48 h of diagnosis | 27/223 | (12) |
| Immunocompromising conditions | 84/223 | (38) |
| Previous diagnosis of HSV-2 meningitis | 44/223 | (20) |
| Concurrent HSV-2 ulcers (genital or oral) | 46/223 | (21) |
| Patient indication (ie, patient requests antiviral treatment) | 11/223 | (5) |
| I always treat these patients with antiviralsb | 88/223 | (39) |
| Favored antiviral regimen | ||
| IV acyclovir followed by valacyclovir | 110/179 | (61) |
| Monotherapy with IV acyclovir | 35/179 | (20) |
| Monotherapy with valacyclovir | 34/179 | (19) |
| Duration of treatment (n = 174), d, median (IQR) | 7 | (7–10) |
| Preferred IV acyclovir dosages | ||
| 5 mg/kg 3 times daily | 8/145 | (6) |
| 10 mg/kg 3 times daily | 132/145 | (91) |
| 15 mg/kg 3 times daily | 5/145 | (3) |
| Preferred valacyclovir dosages | ||
| 1000 mg 3 times daily | 122/144 | (85) |
| 1000 mg 4 times daily | 3/144 | (2) |
| 2000 mg 3 times daily | 12/144 | (8) |
| 2000 mg 4 times daily | 2/144 | (1) |
| Other | 5/144 | (3) |
| Adjunctive dexamethasone | 2/189 | (1) |
| Treat immunocompromised patients differently | 110/189c | (58) |
Abbreviations: HSV-2, herpes simplex virus type 2; IQR, interquartile range; IV, intravenous.
a
Several choices possible.
b
Automatically excludes other answers.
c
Prolonged total duration of treatment (n = 36), prolonged IV acyclovir (n = 31), and always treat with antivirals (n = 25).