Editing Encephalitis (section)

==Treatment==
An ideal drug to treat brain infection should be small, moderately lipophilic at pH of 7.4, low level of plasma protein binding, volume of distribution of litre per kg, does not have strong affinity towards binding with [[P-glycoprotein]], or other efflux pumps on the surface of [[blood–brain barrier]]. Some drugs such as isoniazid, pyrazinamide, linezolid, metronidazole, fluconazole, and some fluoroquinolones have good penetration to blood brain barrier.<ref name="pmid20930076">{{Cite journal |vauthors=Nau R, Sörgel F, Eiffert H |date=October 2010 |title=Penetration of drugs through the blood-cerebrospinal fluid/blood-brain barrier for treatment of central nervous system infections |journal=Clinical Microbiology Reviews |volume=23 |issue=4 |pages=858–883 |doi=10.1128/CMR.00007-10 |pmc=2952976 |pmid=20930076}}</ref> Treatment (which is based on supportive care) is as follows:<ref>{{MedlinePlus|001415|Encephalitis}}</ref>
{{columns-list|colwidth=30em|
* [[Antiviral]] medications (if virus is cause)
* [[Antibiotics]], (if bacteria is cause)
* [[Steroids]] are used to reduce brain swelling
* [[Sedatives]] for restlessness
* [[Acetaminophen]] for fever
* [[Occupational therapy|Occupational]] and [[physical therapy]] (if brain is affected post-infection)
}}

[[Pyrimethamine]]-based maintenance therapy is often used to treat toxoplasmic encephalitis (TE), which is caused by ''[[Toxoplasma gondii]]'' and can be life-threatening for people with weak immune systems.<ref name="Connollyetal2017">{{Cite journal |vauthors=Connolly MP, Goodwin E, Schey C, Zummo J |date=February 2017 |title=Toxoplasmic encephalitis relapse rates with pyrimethamine-based therapy: systematic review and meta-analysis |journal=Pathogens and Global Health |volume=111 |issue=1 |pages=31–44 |doi=10.1080/20477724.2016.1273597 |pmc=5375610 |pmid=28090819}}</ref> The use of [[highly active antiretroviral therapy]] (HAART), in conjunction with the established pyrimethamine-based maintenance therapy, decreases the chance of relapse in patients with HIV and TE from approximately 18% to 11%.<ref name="Connollyetal2017" /> This is a significant difference as relapse may impact the severity and prognosis of disease and result in an increase in healthcare expenditure.<ref name="Connollyetal2017" />

The effectiveness of [[Intravenous therapy|intravenous]] [[immunoglobulin]] for the management of childhood encephalitis is unclear. [[Systematic review]]s have been unable to draw firm conclusions because of a lack of [[randomised]] [[double-blind]] studies with sufficient numbers of patients and sufficient follow-up.<ref name=":0">{{Cite journal |vauthors=Iro MA, Martin NG, Absoud M, Pollard AJ |date=October 2017 |title=Intravenous immunoglobulin for the treatment of childhood encephalitis |journal=The Cochrane Database of Systematic Reviews |volume=2017 |issue=10 |pages=CD011367 |doi=10.1002/14651858.CD011367.pub2 |pmc=6485509 |pmid=28967695}}</ref> There is the possibility of a benefit of intravenous immunoglobulin for some forms of childhood encephalitis on some indicators such as length of hospital stay, time to stop spasms, time to regain consciousness, and time to resolution of neuropathic symptoms and fever.<ref name=":0" />  Intravenous immunoglobulin for [[Japanese encephalitis]] appeared to have no benefit when compared with [[placebo]] (pretend) treatment.<ref name=":0" />