Treatment of VZV Encephalitis in Patients with End-Stage Renal Disease

Immediate Antiviral Therapy

For patients with end-stage renal disease (ESRD) and VZV encephalitis, the American College of Physicians and the Infectious Diseases Society of America recommend initiating intravenous acyclovir immediately at 5-7.5 mg/kg every 24 hours (or after each dialysis session), with mandatory dose adjustment for renal impairment 1, 2, 3
The standard dose of acyclovir for VZV encephalitis in patients with normal renal function is 10 mg/kg IV every 8 hours, as recommended by the Infectious Diseases Society of America 1, 2, 4

The treatment duration for confirmed VZV encephalitis is 14-21 days, as recommended by the Clinical Infectious Diseases society 4, 3
Repeat lumbar puncture should be performed at the end of treatment to confirm CSF PCR negativity for VZV, as recommended by the Praxis Medical Insights 3

The Infectious Diseases Society of America recommends not using corticosteroids routinely in VZV encephalitis, but adding them if there is vasculitic involvement or stroke-like presentation 1, 2, 3
If vasculopathy is present, prednisolone 60-80 mg daily for 3-5 days may be added due to the inflammatory nature of the lesion, as recommended by the Journal of Infection 1, 2, 6, 3

Immunocompromised patients with VZV encephalitis may require prolonged courses of IV acyclovir beyond 14-21 days, as recommended by the Journal of Infection and the Kidney International 1, 2, 6
In kidney transplant recipients with VZV encephalitis, IV acyclovir with dose adjustment for renal function and consideration of reducing immunosuppression is recommended by the Kidney International and the Praxis Medical Insights 7, 3