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Introduction Timely administration of IV aciclovir reduces mortality in HSV encephalitis. Early diagnosis is however challenging due to non-specific symptoms and delays in obtaining relevant investigation results. Current practice involves routine administration of aciclovir in cases of suspected meningitis, an approach not supported by the NICE.Objectives Evaluate the diagnostic approach to suspected viral encephalitis.Methods Retrospective cohort study of 410 patients over 16 years old prescribed IV aciclovir for suspected viral encephalitis at a London healthcare trust between 2021 and 2024.Results IV aciclovir was often prescribed when meningitis, rather than encephalitis, was suspected – with 29% with meningism on presentation and 17% with meningitis as the first documented differential diagnosis.29% fulfilled diagnostic criteria for possible or probable encephalitis and 5% did not fulfil any of these criteria. 38% had no microbiological or serological testing for HSV/VZV. 5% still had a diagnosis of suspected viral encephalitis at discharge.Conclusions and Recommendations While acknowledging the challenge of early diagnosis and risk of missing a diagnosis of true viral encephalitis, we recommend a review of routine prescription of IV aciclovir in suspected meningitis, emphasis on altered mental status as a useful distinguishing feature and dedicated NICE guidelines for suspected encephalitis.a.wakelin@hotmail.co.uk