Algorithm for the Treatment of Asymptomatic Neonates Following Vaginal or Cesarean Delivery to People With Active Genital Herpes Lesions

Algorithm for the Treatment of Asymptomatic Neonates Following Vaginal or Cesarean Delivery to People With Active Genital Herpes Lesions Herpes Infections

«Flowchart»

Patient remains asymptomatic, CSF indices not indicative of infection, CSF and blood NAATs negative, and normal serum ALT^a

Treatment of Infection and Proven Disease

Treat with intravenous acyclovir at 60 mg/kg/DAY in three divided daily doses for 14 days (SEM) or 21 days (CNS or disseminated)

Additional evaluation may be indicated

Preemptive Therapy of Infection but No Proven Disease

Treat with intravenous acyclovir at 60 mg/kg/DAY in three divided daily doses fo 10 days^c

End

D/C intravenous acyclovir after 21-day treatment course

Continue intravenous acyclovir for 7 days more

End

^bIf evidence of CNS disease at begining of therapy

Repeat CSF HSV NAAT near end of 21-day course of treatment^b

^cInfants managed with 10 days of preemptive antiviral therapy should not subsequently receive oral acyclovir suppression, since their HSV exposure never progressed to infection or disease

^a Serum ALT values in neonates may be elevated due to noninfectious causes (delivery-related perfusion, etc). For this algorithm, ALT values more than two-times the upper limit of normal may be considered suggestive of neonatal disseminated HSV disease for HSV-exposed neonates