Antibiotics in Encephalitis: AIIMS guidelines

Delhi: All India institute of medical sciences has released guidelines on antibiotics use in various infections. Under the section of neurological infections the management of Encephalitis. Encephalitis often leads to only mild flu-like non-specific signs and symptoms — such as a fever or headache — or no symptoms at all. Sometimes the flu-like symptoms are more severe. Encephalitis can also cause confused thinking, seizures, or problems with senses or movement. often causes only mild flu-like signs and symptoms — such as a fever or headache — or no symptoms at all. Sometimes the flu-like symptoms are more severe. Encephalitis can also cause confused thinking, seizures, or problems with senses or movement.

Main recommendations are:

Encephalitis :

When to suspect?

Encephalitis should be suspected in all patients with fever and altered sensorium. Other supportive findings include new seizures, focal neurologic signs, and radiological abnormalities. The threshold to suspect should be low as delay in diagnosis can be fatal.

How to diagnose?

The investigations that should be obtained in all patients with suspected encephalitis include complete blood count with differential, electrolytes, renal and liver function tests, blood cultures, appropriate tests for diagnosing HIV, malaria, dengue, scrub typhus and leptospirosis.

Lumbar puncture - Cerebrospinal fluid- opening pressure, cell count and differential, protein, glucose, gram stain, bacterial cultures, and HSV-1/HSV-2 polymerase chain reaction (PCR) for all patients. Other viruses specific polymerase chain reaction may be considered in suspected cases. Polymerase chain reaction for bacteria when available should be sought.

Magnetic resonance imaging (MRI) of the brain should be performed in all patients. Computed tomography should be used only if Magnetic resonance imaging is unavailable or cannot be performed.

Etiology: Herpes simplex virus, Malaria, scrub typhus, dengue, leptospirosis and other viruses in addition to causes listed for meningitis

Treatment: The treatment is as follows-

Ceftriaxone 2 gm IV BD plus Vancomycin 1-2 gm IV BD+ intravenous Acyclovir 10 mg/kg TDS + Doxycycline 100 mg BD

Special remarks:

Malaria should be ruled out by at-least two rapid diagnostic tests 12 hours apart