During the Emergency Department Evaluation of a Well Appearing Neonate with Fever, Should Empiric Acyclovir be Initiated?

Reviewed and approved by the AAEM Board of Directors (7/10/2017)

During the assessment of a febrile neonate, defined as less than 28 days of age, initiation of a full septic work-up including blood, urine and cerebrospinal fluid (CSF) analysis followed by administration of broad spectrum antibiotics is standard. Consideration of testing and treatment for possible herpes simplex virus (HSV) infection in this situation is a controversial topic lacking evidence from well-designed clinical research. No accepted standard currently exists defining the evaluation and management of HSV in a well appearing febrile neonate. The aim of this statement is to provide emergency physicians with guidance on the evaluation, testing and treatment of possible HSV infection in neonates presenting with fever alone.

Continue Reading

Reference and Literature Grading (PDF)