A term neonate born to a mother with a history of genital herpes develops vesicular skin lesions, seizures, and CSF pleocytosis at 10 days of age. The neonate's CSF HSV PCR is positive. What is the MOST appropriate treatment and its duration?

• A IV acyclovir 20 mg/kg/dose every 8 hours for 14 days
• B IV acyclovir 20 mg/kg/dose every 8 hours for 21 days ✓
• C IV ganciclovir 6 mg/kg/dose every 12 hours for 6 weeks
• D IV acyclovir 10 mg/kg/dose every 8 hours for 21 days

Explanation

This is disseminated neonatal herpes simplex virus (HSV) with CNS involvement. Per AAP Red Book and standard neonatal guidelines, all forms of neonatal HSV are treated with IV acyclovir at 20 mg/kg/dose every 8 hours (60 mg/kg/day). Duration varies by classification: skin-eye-mouth (SEM) disease receives 14 days; CNS disease and disseminated disease require 21 days of IV acyclovir. With CNS involvement confirmed by positive CSF PCR, 21 days is mandatory. Following IV therapy, oral acyclovir suppressive therapy (300 mg/m²/dose TID) is given for 6 months to reduce neurological sequelae. IV ganciclovir is used for congenital CMV, not HSV.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.