{ "schema_version": 1, "kind": "condition", "id": "encephalitis-referral", "name": "Encephalitis (Emergency Referral)", "category": "infectious", "sources": "Viral Encephalitis - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470162/", "review_status": "reviewed", "verified_against": "Encephalitis (Emergency Referral) - disease-level clinical article (encephalitis-referral-clinical.txt) ยท Viral Encephalitis - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470162/", "verified_date": "2026-08", "treatments": [ { "id": 675, "generic": "Acyclovir", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": 250.0, "adult_dose": "10 mg/kg intravenously every 8 hours", "adult_duration": "14 to 21 days", "dose_source": "Viral Encephalitis - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470162/", "rationale": "The cited article states that treatment of viral encephalitis is otherwise supportive, that herpes simplex encephalitis is the very important exception, and that acyclovir started early significantly reduces death and disability and limits long-term behavioural and cognitive damage. On the strength of that it recommends starting every patient with suspected encephalitis on acyclovir empirically, and gives the dose as 10 mg/kg intravenously every 8 hours for 14 to 21 days. The Egyptian formulary chapters held here contain no acyclovir monograph, so both the indication and the dose come from that article and it is named on the row.", "cautions": [ "THE DRUG DOES NOT REPLACE THE TRANSFER - IT IS WHAT THE TRANSFER IS FOR. This is intravenous, inpatient treatment alongside neuroimaging and a lumbar puncture. Do not hold a patient in the clinic to give anything by mouth.", "START IT ON SUSPICION, NOT ON PROOF. The article's recommendation is empirical treatment of every suspected case, because the benefit of acyclovir in herpes simplex encephalitis depends on how early it is started.", "IMAGE BEFORE THE LUMBAR PUNCTURE where raised intracranial pressure or a risk of uncal herniation is possible.", "IT IS NOT THE DOSE FOR EVERY VIRUS. The same article gives 10 to 15 mg/kg every 8 hours for 10 to 14 days for varicella-zoster, with corticosteroids possibly added in an immunocompetent patient, and for cytomegalovirus a different pair of drugs entirely - ganciclovir 5 mg/kg every 12 hours with foscarnet 60 mg/kg every 8 hours or 90 mg/kg every 12 hours, for 21 days. Which of these applies is a decision for the admitting unit.", "Suspect encephalitis on fever, headache, altered consciousness or seizures." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The article states no separate paediatric or neonatal dose, and neonatal herpes simplex is dosed differently from the figure above, so none is printed. A child with suspected encephalitis goes in on the same emergency pathway and the dose comes from the admitting paediatric team.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "SUPRAVIRAN 250MG I.V VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GRUNENTHAL-GERMANY > AL KAMAL IMPORTING & MARKETING CO", "price_egp": 40.0, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ACICLOVIR VIATRIS 250 MG 5 VIALS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "REIG JOFRE > VIATRIS", "price_egp": 530.0, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ACIGLOTIR 250 MG LYOPH. PD. FOR IV INF. 5 VIALS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLOBAL PHARMACEUTICAL INDUSTRIES", "price_egp": 530.0, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ZOVIRAX 250MG 5 I.V. INF. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GLAXO SMITHKLINE", "price_egp": 910.0, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "encephalitis-referral" }, { "id": 676, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Immediate emergency transfer to hospital for IV acyclovir and lumbar puncture", "adult_duration": "Immediate emergency transfer", "dose_source": "No dose - emergency referral pathway, no medicine given in primary care", "rationale": "Encephalitis is a time-critical emergency requiring inpatient IV antiviral therapy and neuroimaging.", "cautions": [ "TIME-CRITICAL EMERGENCY: Do not delay transfer to administer oral antivirals in primary care.", "Suspect in patients with fever, headache, altered mental status, or seizures.", "RED FLAG - Exclude increased intracranial pressure and uncal herniation risk via neuroimaging (CT/MRI) prior to lumbar puncture." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Immediate emergency pediatric intensive care transfer", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "encephalitis-referral" } ] }