Treatment: Varicella-Zoster Virus Infections

• Chickenpox: Antiviral therapy can be helpful if started within 24 h of symptom onset.
  • - For children <12 years of age, acyclovir (20 mg/kg PO q6h) is recommended.
  • - For adolescents and adults, acyclovir (800 mg PO five times daily), valacyclovir (1 g PO tid), or famciclovir (250 mg PO tid) for 5-7 days is recommended.
  • - Good hygiene, meticulous skin care, and antipruritic drugs are important to relieve symptoms and prevent bacterial superinfection of skin lesions.
• Zoster: Lesions heal more quickly with antiviral treatment.
  • - Famciclovir (500 mg PO tid for 7 days) or valacyclovir (1 g PO tid for 5-7 days) is preferred over acyclovir (800 mg PO five times daily for 7-10 days), given superior pharmacokinetics and pharmacodynamics.
• VZV infection in severely immunocompromised pts: Severely immunocompromised pts should receive parenteral acyclovir, at least at the outset (10 mg/kg IV q8h for 7 days), for chickenpox and herpes zoster to reduce the risk of visceral complications, although this regimen does not speed the healing or relieve the pain of skin lesions.
  • - Low-risk immunocompromised pts can be treated with oral valacyclovir or famciclovir.
  • - If feasible, immunosuppression should be decreased during concomitant acyclovir administration.
• Zoster ophthalmicus: Antiviral treatment, analgesics for severe pain, and immediate consultation with an ophthalmologist are required.
• Postherpetic neuralgia: Gabapentin, pregabalin, amitriptyline, lidocaine patches, and fluphenazine may relieve pain and can be given along with routine analgesic agents. Prednisone (given along with antiviral therapy at 60 mg/d for the first week of zoster and then at a dose tapered by 50% weekly over the next 2 weeks) can accelerate quality-of-life improvements, including a return to usual activity; prednisone treatment is indicated only for healthy elderly persons with moderate or severe pain at presentation.