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Vidarabine versus acyclovir therapy in herpes simplex encephalitis.

R J Whitley, C A Alford, M S Hirsch

    The New England Journal of Medicine
    |January 16, 1986
    PubMed
    Summary

    Acyclovir significantly reduced mortality and improved outcomes for patients with herpes simplex encephalitis compared to vidarabine. This study establishes acyclovir as the preferred treatment for this serious brain infection.

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    Lancet (London, England)·2009

    Area of Science:

    • Neurology
    • Infectious Diseases
    • Pharmacology

    Background:

    • Herpes simplex encephalitis (HSE) is a severe neurological condition.
    • Prompt diagnosis and effective antiviral treatment are crucial for patient survival and recovery.

    Purpose of the Study:

    • To compare the efficacy and safety of vidarabine and acyclovir in treating biopsy-proven herpes simplex encephalitis.
    • To determine the optimal antiviral agent for HSE management.

    Main Methods:

    • A randomized trial involving 208 patients with presumptive HSE.
    • Patients received either vidarabine (15 mg/kg/day) or acyclovir (30 mg/kg/day) for 10 days.
    • Outcomes assessed included mortality, neurological function (Glasgow Coma Scale), and morbidity at six months.

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    Main Results:

    • Of 69 patients with confirmed HSE, mortality was significantly lower with acyclovir (28%) compared to vidarabine (54%) (P=0.008).
    • Acyclovir treatment showed better outcomes across different Glasgow Coma Scale scores, with 0% mortality in patients with scores >10 versus 42% for vidarabine.
    • Six-month functional outcomes were better with acyclovir (38% normal function) than vidarabine (14% normal function) (P=0.021).

    Conclusions:

    • Acyclovir is demonstrably superior to vidarabine for treating biopsy-proven herpes simplex encephalitis.
    • The study identifies acyclovir as the current treatment of choice for HSE, especially in younger patients with higher initial Glasgow Coma Scale scores.