A5V4d

Management by the paediatric specialist
likely to be developmentally normal at 12 months of age, compared with children treated with
standard dose therapy.
A large EL 3 retrospective multicentre study 200 studied prognostic factors for herpes simplex
encephalitis in adult patients. A delay of greater than 2 days between admission to the hospital and
initiation of aciclovir therapy was strongly associated with a poor outcome (OR 3.1, 95% CI 1.1 to 9.1,
P = 0.037). However, there was still a favourable outcome for 55 of the patients (65%).
Evidence summary
Treatment with aciclovir decreases morbidity and mortality in adults and children with herpes simplex
encephalitis. Treatment with aciclovir within 48 hours of admission improves the outcome in herpes
simplex encephalitis.
GDG translation
The GDG recognised the difficulty in the early identification and treatment of children with herpes
simplex encephalitis as the early features may be non-specific. The diagnosis of herpes simplex
encephalitis may not be confirmed for a number of days after admission as initial investigations can
be normal. Early treatment with aciclovir improves outcome in herpes simplex encephalitis.
Recommendations
Number Recommendation
66 Give intravenous aciclovir to children with fever and symptoms and signs
suggestive of herpes simplex encephalitis (see recommendation 26). [2007]
Oxygen
Evidence summary
There was a lack of evidence meeting the inclusion criteria examining the effect upon outcome of
administering oxygen to the child with symptoms and signs of serious illness.
GDG translation
Recommendations regarding treatment with oxygen were made based on GDG consensus.
Recommendations
Number Recommendation
67 Oxygen should be given to children with fever who have signs of shock or oxygen
saturation (SpO2) of less than 92% when breathing air. Treatment with oxygen
should also be considered for children with an SpO2 of greater than 92%, as
clinically indicated. [2007]
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