When Is Empiric Acyclovir Indicated for Herpes Encephalitis After the Neonatal Period?

Herpes simplex virus (HSV) encephalitis is a potentially devastating infection that frequently results in long-term sequelae. Empiric therapy is often warranted in neonates because presentation of perinatally acquired HSV disease can be subtle, and early treatment with acyclovir is associated with better outcomes. However, after the neonatal period, HSV-CNS infection is rare and indications for empiric antiviral therapy are less certain. To characterize empiric testing and treatment practices for HSV infection in children, researchers examined inpatient acyclovir use at 15 U.S. children's hospitals between 1999 and 2012.

During the 14-year study period, the number of HSV cases did not change significantly over time. However, empiric acyclovi…