What is the empiric antiviral treatment for suspected herpes simplex encephalitis?

• A. Antibiotics only
• B. IV acyclovir
• C. Steroids alone
• D. Oral acyclovir

Answer: (B)

The central idea is that suspected herpes simplex encephalitis must be treated immediately with antiviral therapy delivered intravenously. HSV encephalitis can progress rapidly and cause permanent brain damage or death if not treated promptly, so you start therapy before confirmatory tests return. Intravenous acyclovir delivers the drug into the central nervous system at therapeutic levels, which is essential for effectively tackling HSV in the brain. Oral acyclovir does not achieve reliable CNS penetration for acute encephalitis, so it’s not appropriate as initial therapy. Antibiotics alone won’t address the viral cause, and steroids alone don’t treat HSV encephalitis and can potentially worsen things. In adults, the usual regimen is IV acyclovir given every 8 hours for about 14–21 days, with adjustments for renal function. While you obtain MRI and CSF with HSV PCR to confirm the diagnosis, don’t delay starting IV acyclovir when HSV encephalitis is suspected.