Acyclovir use in infants and children significantly increased from 1999 to 2012 without an increase in herpes simplex virus encephalitis incidence. Hospital length of stay was significantly longer for those with non-herpes diagnoses treated with acyclovir when compared to those not treated.
Study Rundown: Herpes simplex virus (HSV) encephalitis is an uncommon, though dangerous disease condition in children and adolescents. As the clinical manifestations of HSV encephalitis differ by age, the empiric diagnostic and therapeutic approaches used in newborns may not be appropriate for older children. Despite this, many practitioners test and treat HSV in a similar manner to that of neonates. Researchers completed this study to examine national HSV empirical treatment trends and factors contributing to HSV testing at pediatric hospitals. Over the course of the 14-year study period, researchers found that acyclovir treatment at 15 pediatric hospitals was initiated with increasing frequency. Treatment rates were especially high among patients ultimately diagnosed with viral meningitis, septicemia, and fever. Researchers also studied HSV testing trends at a single large, pediatric care center, finding that the majority of children tested for HSV lacked features consistent with HSV encephalitis and had negative PCR testing. Although testing was evaluated at only one institution, this study’s broad evaluation of treatment trends suggests that additional hospital costs and potential patient harm may occur as testing and treatment of HSV increases in the absence of clinical features.