Today we heard the story of a young woman with fever, headache, photophobia, and confusion/drowsiness with a normal CT and an LP with a lymphocytic pleocytosis with elevated protein. The presumed diagnosis was viral meningoencephalitis and she was treated with IV acyclovir.
Despite excellent data on bioavailability, there are only case reports of substituting oral valacyclovir for IV acyclovir in the treatment of HSV encephalitis. This would be an interesting option which would decrease the need for IV in patients who recovered after IV "induction". It is biologically plausible because the levels in the plasma achieved by valacyclovir approximate acyclovir without the concomittant nephrotoxicity. Apparently clinical trials are underway.
We have previously blogged about HSV encephalitis here.
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