A neonate has petechiae, hepatosplenomegaly, and a CSF pleocytosis. CSF PCR is positive for HSV. Which of the following is the recommended treatment duration for neonatal HSV CNS disease?
- 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 acyclovir 10 mg/kg/dose every 8 hours for 10 days
- D Oral valacyclovir 25 mg/kg twice daily for 6 months
Correct answer: B. IV acyclovir 20 mg/kg/dose every 8 hours for 21 days
Explanation
Neonatal HSV CNS disease (encephalitis) requires IV acyclovir 20 mg/kg every 8 hours for 21 days, compared to 14 days for disseminated disease without CNS involvement and 14 days for skin-eye-mouth (SEM) disease. This extended duration is necessary to fully clear CNS infection and reduce neurodevelopmental sequelae. After completing IV therapy, oral suppressive acyclovir 300 mg/m²/dose three times daily for 6 months further reduces neurodevelopmental impairment (CASG trial). The dose of 10 mg/kg is the adult dose, not neonatal.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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