›Valproate 40 mg/kg IV (maximum 3000 mg) as alternative
›Status epilepticus refractory
›Midazolam 0.2 mg/kg IV bolus then 0.05 to 0.4 mg/kg/hour infusion
›Propofol 1 to 2 mg/kg IV bolus then 1 to 4 mg/kg/hour infusion
›EEG monitoring to confirm burst suppression
›Cerebral edema and ICP management
›Head of bed elevation 30 degrees
›Venous drainage optimization
›Avoid neck flexion
›Osmotherapy for intracranial hypertension
›Mannitol 0.25 to 1 g/kg IV over 20 minutes
›Serum osmolality target < 320 mOsm/kg
›Hypertonic saline 3% at 75 to 150 mL/hour alternatively
›Target CPP 60 to 70 mmHg
›MAP support with vasopressors if required
›Avoid aggressive hyperventilation except for acute herniation threat
Hemodynamic and vasculitis support
›Vasopressor therapy for shock
›Norepinephrine first-line
›0.01 to 3 mcg/kg/minute IV infusion
›Titrate to MAP >= 65 mmHg
›Central line preferred for delivery
›Vasopressin adjunct for refractory shock
›0.03 to 0.04 units/minute fixed dose IV
›Added when norepinephrine > 0.25 mcg/kg/minute
›Volume resuscitation
›Balanced crystalloid 250 to 500 mL boluses
›Reassess after each bolus for response
›Caution in concurrent ARDS
Antiviral and experimental therapy
›Monoclonal antibody m102.4
›Most promising post-exposure and therapeutic agent
›Cross-reactive against HeV and Nipah virus
›Phase 1 trial: safe up to 20 mg/kg IV
›Dosing from compassionate use experience
›Approximately 19 to 20 mg/kg IV single dose
›Option for repeat dose at 72 hours
›Access via Australian Department of Health or TGA Special Access Scheme
›Administer as early as possible post-exposure
›Delay reduces theoretical benefit
›Coordinate with reference laboratory and public health
›Ribavirin IV
›In-vitro activity but inadequate serum levels clinically
›Serum levels achieved below in-vitro IC90 of 64 mg/L
›No proven efficacy in animal models or human cases
›May be considered compassionate use pending no alternative
›16 mg/kg IV loading dose then 8 mg/kg IV every 8 hours
›Hemolytic anemia monitoring
›Teratogenic: avoid in pregnancy
›Remdesivir
›Protective in NHP models against Nipah virus if initiated within 24 hours of exposure
›No direct human HeV data
›Consider if within early post-exposure window
›Standard dosing from COVID-19 protocol as reference
›200 mg IV day 1 then 100 mg IV daily for up to 10 days
›Renal adjustment if eGFR < 30 mL/min
›Chloroquine and hydroxychloroquine
›Not recommended
›No efficacy in animal models despite in-vitro activity
›Risk of QTc prolongation without benefit
Empiric antimicrobial therapy
›Empiric broad-spectrum antibiotics
›Until bacterial co-infection or secondary infection excluded
›Piperacillin-tazobactam 4.5 g IV every 6 hours
›Adjust dose for renal function
›Antiviral coverage for HSV encephalitis pending PCR
›Acyclovir 10 mg/kg IV every 8 hours
›Adjust for renal function
›Continue until HSV PCR returns negative
›Anticonvulsant prophylaxis
›Levetiracetam for encephalitis-associated seizure prevention
›500 to 1500 mg IV every 12 hours
›Renal dose adjustment required
›Minimal drug interactions compared to phenytoin