CONGENITALLY ACQUIRED INFECTIONS (Treatment)

Herpes Simplex Virus: Treatment

a. Management of neonates with symptomatic/proven HSV disease i. Intravenous acyclovir (20 mg/kg/dose every 8 hours) (a) Duration (1) SEM disease: 14 days (2) Disseminated or localized CNS disease: Minimum of 21 days (b) Monitoring – Twice-weekly neutrophil count is recommended. (c) Add topical ophthalmic drug (e.g., trifluridine) if ocular involvement ii. Oral acyclovir (a) Not recommended for treatment of HSV infections (b) Used as suppressive therapy after treatment of an acute HSV infection (1) Shown to prevent skin recurrences – Occurs in 50% of infants after neonatal HSV infection (2) Improves neurodevelopmental outcomes after CNS disease (3) Regimen: 300 mg/m2/dose given three times daily for 6 months.

b. Management of asymptomatic neonates born to women with active genital HSV lesions i. If no history of maternal genital HSV, the neonate is evaluated at 24 hours of age with surface cultures, CSF and blood HSV PCR, and liver function tests AND acyclovir is initiated; maternal serology should be sent to determine infection classification (i.e., recurrent, firstepisode primary, first-episode nonprimary) (a) If maternal serologies reveal recurrent infection AND neonatal laboratory values remain negative at 48–72 hours, discontinue acyclovir. (b) If maternal serologies reveal recurrent infection AND neonatal PCR or cultures are positive, continue acyclovir. (1) If the neonate remains asymptomatic AND CSF and blood PCR are negative and ALT is normal, complete 10 days of preemptive therapy. (2) If the neonate remains asymptomatic but the PCR is positive or ALT is more than 2 times the upper limit of normal, treat for proven disease (see “Duration” above in VIII.A.4.a.i.(a)). (c) If maternal serologies reveal first-episode primary or nonprimary, continue acyclovir. (1) If the neonate remains asymptomatic AND CSF and blood PCR are negative and ALT is normal, complete 10 days of preemptive therapy. (2) If the neonate remains asymptomatic but the PCR is positive or ALT is more than 2 times the upper limit of normal, treat for proven disease (see “Duration” above). ii. If the mother has a history of genital HSV before pregnancy, the neonate is evaluated at 24 hours of age with surface cultures and blood PCR; acyclovir is NOT initiated. (a) If neonatal laboratory values remain negative, no therapy is needed. (b) If neonatal surface cultures or PCR results are positive, CSF PCR and liver function tests are sent AND acyclovir is initiated. (1) If the neonate remains asymptomatic AND CSF and blood PCR are negative and ALT is normal, complete 10 days of preemptive therapy. (2) If the neonate remains asymptomatic but PCR is positive or ALT is more than 2 times the upper limit of normal, treat for proven disease