Eastern Equine Encephalitis Medication

  • Author: Mohan Nandalur, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jun 9, 2011
 

Medication Summary

Drugs currently used in the treatment of eastern equine encephalitis (EEE) are those capable of ameliorating neurologic complications. No current studies provide convincing evidence for or against prophylactic use. Potentially used medications include phenytoin, phenobarbital, or a benzodiazepine drip.

Use antipyretics as needed. Additionally, appropriate analgesics and amnestics can be used once the patient is intubated. Antibiotics are not of value in these situations and may predispose patients to superinfections. After determining that the patient does not have a bacterial infection, discontinue antibiotics.

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Anticonvulsants

Class Summary

Because of the high prevalence of seizures in patients with EEE, anticonvulsants are appropriate.

Phenytoin (Dilantin, Phenytek)

 

Phenytoin may act in the motor cortex, where it may inhibit spread of seizure activity. Activity of brain stem centers responsible for the tonic phase of grand mal seizures also may be inhibited. Individualize the dosage, and administer a larger dose before retiring if the dose cannot be divided equally. To avoid hypotension and arrhythmia, the rate of infusion must not exceed 50 mg/min.

Diazepam (Valium, Diastat)

 

Any of the benzodiazepines may be effective in the short term. Most often, diazepam or lorazepam is recommended. Diazepam depresses all levels of the central nervous system (eg, limbic system, reticular formation), possibly by increasing the activity of gamma-aminobutyric acid (GABA). Individualize the dosage, and increase it cautiously to avoid adverse effects.

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Corticosteroids

Class Summary

Early initiation serves multiple purposes (eg, decreases inflammation, decreases cerebral edema, treats potential adrenocortical dysfunction).

Dexamethasone (Baycadron)

 

Dexamethasone is a potent corticosteroid usually administered intravenously (IV) in these situations. It is used for various allergic and inflammatory diseases. It decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.

Methylprednisolone (Solu-Medrol, A-Methapred, Depo-Medrol)

 

Methylprednisolone is an IV steroid often used early. It decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

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Antipyretics

Class Summary

These agents are used to reduce fever in patients with eastern equine encephalitis.

Acetaminophen (Acephen, Aspirin Free Anacin, FeverAll)

 

Inhibits action of endogenous pyrogens on heat-regulating centers; reduces fever by a direct action on the hypothalamic heat-regulating centers, which, in turn, increase the dissipation of body heat via sweating and vasodilation.

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Contributor Information and Disclosures
Author

Mohan Nandalur, MD  Staff Physician, Department of Internal Medicine, Section of Cardiovascular Medicine, Washington Hospital Center

Mohan Nandalur, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians-American Society of Internal Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Andrew W Urban, MD  Chief, Section of Infectious Diseases, Middleton Memorial Veterans Hospital; Clinical Assistant Professor, Department of Internal Medicine, University of Wisconsin at Madison School of Medicine and Public Health

Andrew W Urban, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Gary L Gorby, MD  Associate Professor, Departments of Internal Medicine and Medical Microbiology and Immunology, Division of Infectious Diseases, Creighton University School of Medicine; Associate Professor of Medicine, University of Nebraska Medical Center; Associate Chair, Omaha Veterans Affairs Medical Center

Gary L Gorby, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and New York Academy of Sciences

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

John L Brusch, MD, FACP  Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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