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.
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.
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.
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.
