Empiric therapy with acyclovir may be indicated in a neonate with evidence of herpes simplex viral infection.
Presence of one or more manifestations of neonatal herpes disease (while awaiting confirmation):
(1) skin vesicles
(2) mouth ulcers
(3) conjunctivitis
Encephalitis with no other cause identified, especially in combination with sepsis syndrome, pneumonitis, or hepatitis.
Sepsis syndrome plus 1 or more of the following:
(1) negative cultures (blood, CSF, urine) for bacteria and fungi AND no previous antibiotic therapy in the mother or infant
(2) positive HSV culture from maternal vagina at the time of delivery
(3) a history of genital herpes in the mother and/or father
(4) recent close contact of the infant with a person with evidence of active HSV disease
where:
• The presence of positive viral cultures or PCR would mean that the therapy would no longer be empiric.
• Recent antibiotic therapy could mask a bacterial etiology by causing false negative cultures. Maternal antibiotic therapy is probably relevant during the first 24 hours after delivery.
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