Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

West Nile fever

1st line – supportive treatment

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ACUTE
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West Nile fever
1st line – 

supportive treatment

Recommend rest, generous fluid intake, and treatment of symptoms with non-prescription medications such as paracetamol.

Advise the patient to seek medical attention if the symptoms can no longer be adequately managed by non-prescription medications (e.g., severe dehydration) or if they last more than 1 week. Advise the patient to seek immediate medical care if they develop signs or symptoms of neuroinvasive disease (e.g., severe headache, photophobia, seizures, or changes in mental state).

.[3][78][76]

Primary options

paracetamol: 500-1000 mg orally every 4-6 hours when required, maximum 4000 mg/day

West Nile neuroinvasive disease

1st line – supportive treatment

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ACUTE
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West Nile neuroinvasive disease
1st line – 

supportive treatment

Admit patient to hospital, start intensive supportive care immediately (e.g., intravenous fluids, respiratory support, seizure management, infection management, prevention of venous thromboembolism), and manage any other sequelae of meningitis, encephalitis, or paralysis.[3][78][76]

Patients with encephalitis require close monitoring for the development of seizures or elevated intracranial pressure.[79]

Patients with encephalitis or poliomyelitis should have their airway monitored as acute respiratory failure can develop rapidly. Ventilatory support for a prolonged period may be required.[79]

Rule out other treatable illnesses such as bacterial meningitis, herpes simplex encephalitis, or Guillain-Barre syndrome.

Plus – intravenous aciclovir

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ACUTE
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West Nile neuroinvasive disease
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if herpes simplex infection cannot be excluded
Plus – 

intravenous aciclovir

Treatment recommended for ALL patients in selected patient group

Herpes simplex infection has a definitive effective treatment but is often more difficult to exclude than other treatable conditions such as bacterial meningitis. Therefore, if herpes simplex infection cannot be excluded, and none of the other differentials can be confirmed, give intravenous acyclovir.[77]

Primary options

aciclovir: 10 mg/kg intravenously every 8 hours for 10-21 days or until herpes simplex infection is excluded

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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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