Treatment of Shingles with Antiviral Therapy

First-Line Treatment Options

The Centers for Disease Control and Prevention recommends acyclovir 800 mg orally five times daily for 7-10 days as an effective treatment option, although it requires more frequent dosing which may reduce compliance 1

Immunocompromised patients with shingles require more aggressive management, including intravenous acyclovir 5 mg/kg every 8 hours for severe cases 2
The Centers for Disease Control and Prevention suggests that immunosuppressive therapy should be discontinued in severe cases of varicella infection and disseminated herpes zoster, although this specific guidance is from the Journal of Crohn's and Colitis 3

Using topical acyclovir is substantially less effective than oral therapy and is not recommended, as stated by the MMWR Recommendations and Reports 1
Inadequate dosing or duration of therapy may lead to treatment failure and increased risk of complications, according to the MMWR Recommendations and Reports 1
Failing to recognize and appropriately manage herpes zoster in immunocompromised patients, who may require more aggressive therapy, is a common pitfall to avoid, as suggested by the Journal of Crohn's and Colitis and the MMWR Recommendations and Reports 2, 3

Monitor for complete resolution of lesions; treatment may need to be extended if healing is incomplete after the initial course, as recommended by the MMWR Recommendations and Reports 1