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J R Soc Med. 1994 January; 87(1): 7–8.
PMCID: PMC1294270

The use of acyclovir in suspected encephalitis.


The early use of intravenous acyclovir in herpes simplex encephalitis (HSE) is essential. However, rapid diagnostic tests are not freely available. Hence, all patients with suspected encephalitis may need to be commenced on acyclovir. In our study, of 34 patients with suspected encephalitis, only two eventually had HSE confirmed, 19 had encephalitis not due to herpes simplex and in 13 a non-encephalitis illness was finally diagnosed. Guidelines for the use of acyclovir in suspected encephalitis are given aimed at minimizing the drug cost whilst still protecting all cases of presumed HSE.

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Selected References

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  • Sköldenberg B, Forsgren M, Alestig K, Bergström T, Burman L, Dahlqvist E, Forkman A, Frydén A, Lövgren K, Norlin K, et al. Acyclovir versus vidarabine in herpes simplex encephalitis. Randomised multicentre study in consecutive Swedish patients. Lancet. 1984 Sep 29;2(8405):707–711. [PubMed]
  • Whitley RJ, Alford CA, Hirsch MS, Schooley RT, Luby JP, Aoki FY, Hanley D, Nahmias AJ, Soong SJ. Vidarabine versus acyclovir therapy in herpes simplex encephalitis. N Engl J Med. 1986 Jan 16;314(3):144–149. [PubMed]
  • Schroth G, Gawehn J, Thron A, Vallbracht A, Voigt K. Early diagnosis of herpes simplex encephalitis by MRI. Neurology. 1987 Feb;37(2):179–183. [PubMed]
  • Aurelius E, Johansson B, Sköldenberg B, Staland A, Forsgren M. Rapid diagnosis of herpes simplex encephalitis by nested polymerase chain reaction assay of cerebrospinal fluid. Lancet. 1991 Jan 26;337(8735):189–192. [PubMed]
  • Rothman AL, Cheeseman SH, Lehrman SN, Cederbaum A, Glew RH. Herpes simplex encephalitis in a patient with lymphoma. Relapse following acyclovir therapy. JAMA. 1988 Feb 19;259(7):1056–1057. [PubMed]

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