Empirical acyclovir should be initiated in all patients with suspected encephalitis, pending results of diagnostic studies.
Other empirical antimicrobial agents should be initiated based on specific epidemiologic or clinical factors, including appropriate therapy for presumed bacterial meningitis, if clinically indicated.
In patients who present with acute meningitis, an important diagnostic consideration is whether the patient has enteroviral meningitis.
Rapid detection of enteroviruses by PCR has emerged as a valuable technique that may be helpful in establishing the diagnosis of enteroviral meningitis
Once an etiologic agent of encephalitis is identified, antimicrobial therapy should be targeted to that infectious agent, or therapy should be discontinued if treatment directed against the etiologic agent is not available.
Herpes simplex virus
Varicella zoster virus