Which medications in the drug class Antivirals are used in the treatment of Aseptic Meningitis?

Updated: Jul 17, 2018
  • Author: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

Antivirals

These agents interfere with viral replication; they weaken or abolish viral activity.

Acyclovir (Zovirax)

A prodrug activated by cellular enzymes, acyclovir inhibits the activity of HSV-1, HSV-2, and varicella-zoster virus by competing for viral DNA polymerase and incorporation into viral DNA. Acyclovir is used in HSV meningitis.

Foscarnet (Foscavir)

Foscarnet is an organic analog of inorganic pyrophosphate that inhibits the replication of known herpesviruses, including CMV, HSV-1, and HSV-2. It inhibits viral replication at the pyrophosphate-binding site on virus-specific DNA polymerases. Foscarnet is used to treat CMV meningitis in immunocompromised hosts at induction doses of 60 mg/kg IV q8h and maintenance doses of 90-120 mg/kg IV q24h.

Valacyclovir (Valtrex)

Valacyclovir is a prodrug rapidly converted to the active drug acyclovir. It is more expensive than acyclovir but has a more convenient dosing regimen. The adult dosage is 500 mg orally twice a day for 5-10 days.

Risk of hyperkalemia is increased in patients taking angiotensin-converting enzyme (ACE) inhibitors, cyclosporine, and potassium-sparing diuretics. Use with caution in patients with renal failure (decrease the dose) and patients also taking nephrotoxic drugs. Valacyclovir is associated with onset of hemolytic uremic syndrome. Valacyclovir is a pregnancy category B drug.


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