During the Emergency Department Evaluation of a Well Appearing Neonate (<30 days of age) with a Fever, Should Empiric Acyclovir be Initiated?

Reviewed and approved by the AAEM Board of Directors 1/11/2010.

  1. Define the Issue and State the Question
    • A. Topic Area: PEDIATRIC FEVER: NEONATAL HERPES INFECTION
    • B. General Issue: NEONATAL HERPES INFECTION
    • C. Specific Question: DURING THE EMERGENCY DEPARTMENT EVALUATION OF A WELL APPEARING NEONATE (<30 DAYS OF AGE) WITH A FEVER, SHOULD EMPIRIC ACYCLOVIR BE INITIATED?
    • D. Executive Summary: The diagnosis and management of neonatal herpes is a complex topic. The clinical decision to consider herpes simplex virus and to initiate antiviral therapy should not be taken lightly, nor should it be avoided given the associated morbidity and mortality. Unfortunately, there is a lack of well-designed clinical research that directly answers the question of whether empiric acyclovir should be initiated during the evaluation of a well appearing febrile neonate (please see Discussion for further information).
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