Acyclovir versus vidarabine in herpes simplex encephalitis. Randomised multicentre study in consecutive Swedish...

Area of Science:

• Neurology
• Infectious Diseases
• Pharmacology

Background:

• Herpes simplex encephalitis (HSE) is a severe neurological condition.
• Prompt diagnosis and effective treatment are critical for patient survival and recovery.
• Antiviral medications are the cornerstone of HSE management.

Purpose of the Study:

• To compare the efficacy and safety of acyclovir versus vidarabine in treating HSE.
• To evaluate patient mortality, recovery rates, and long-term sequelae in HSE patients receiving either acyclovir or vidarabine.

Main Methods:

• A prospective, randomized study involving 127 patients with suspected HSE.
• Treatment arms included acyclovir (10 mg/kg 8-hourly) and vidarabine (15 mg/kg daily) for 10 days.
• Diagnosis confirmation via brain biopsy and/or serological antibody responses; efficacy analysis on 51 confirmed cases.

Main Results:

• Acyclovir demonstrated significantly lower mortality (19%) compared to vidarabine (50%) (p=0.04).
• More acyclovir-treated patients achieved normal life (56%) versus vidarabine (13%) (p=0.002).
• Acyclovir group had fewer deaths or severe sequelae (33%) than the vidarabine group (76%) (p=0.005).

Conclusions:

• Acyclovir is a superior treatment for herpes simplex encephalitis compared to vidarabine.
• Acyclovir significantly reduces mortality and improves functional recovery in HSE patients.
• No new or significant adverse events were noted for either drug.