Aseptic meningitis medical therapy


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Overview
Treatment is needed for fungal or mycobacterial causes of aseptic meningitis. Herpesvirus or varicella (chickenpox) virus may be treated with antiviral medicines. Treatment for noninfectious causes consists of pain medications and managing complications, if they occur. No specific treatment is available for enteroviral or most other viral forms of aseptic meningitis.

Treatment
No specific treatment for viral meningitis exists at this time. Most patients completely recover on their own. Doctors often will recommend bed rest, plenty of fluids, and medicine to relieve fever and headache.

Anti-pathogenic
If the causative organism has been identified and has a specific therapy, this should be started.

Bacteria
Even though true aseptic meningitis cannot be caused by pyogenic bacteria, broad-spectrum antibiotic cover should be started as the consequences of misdiagnosing a bacterial meningitis are dire, and relatively easily avoided. For non-pyogenic bacteria, local sensitivities should be taken into account, but generally broad-spectrum is best. Some bacteria are normally sensitive to certain drugs - for example, rifampicin is good for Brucella.

Viruses
HSV, varicella and CMV have a specific antiviral therapy; most other viruses do not. For HSV the treatment of choice is acyclovir.

Fungi
Amphotericin B and fluconazole are the best antifungals in most situations.

Supportive
This will be the majority of the treatment. Fluids, analgesia and antiemetics should cover most cases. Antipyretics should be used judiciously - fever can be a natural response. Steroids are not recommended unless raised intracranial pressure occurs. Phenytoin and other anticonvulsants can be used is seizures occur, but prophylaxis is not recommended.