Aciclovir Treatment Guidelines for Chickenpox

Dosing Recommendations

The Centers for Disease Control and Prevention recommends that patients with chickenpox should be administered aciclovir at a dose of 20 mg/kg body weight orally per dose (maximum 800 mg/dose) 4 times daily for 7-10 days or until no new lesions appear for 48 hours 1, 2
For children less than 45 kg, the American Academy of Pediatrics recommends aciclovir 20 mg/kg body weight (maximum 400 mg/dose) per dose orally 3-4 times daily for 5-10 days 1, 3
Adults and adolescents should receive aciclovir 800 mg orally 4-5 times daily for 7-10 days, as recommended by the Centers for Disease Control and Prevention 4, 1

The Centers for Disease Control and Prevention recommends that treatment should be considered for patients over 12 years of age 4
Treatment should also be considered for patients with chronic cutaneous or pulmonary disorders, patients receiving long-term salicylate therapy, patients receiving short, intermittent, or aerosolized courses of corticosteroids, and secondary household contacts of infected children, as recommended by the Centers for Disease Control and Prevention 4
Immunocompromised patients may require higher doses or IV formulations of aciclovir, according to the Centers for Disease Control and Prevention 5

For immunocompromised patients with severe disease or at high risk for complications, the Centers for Disease Control and Prevention recommends that intravenous aciclovir should be considered 1
The dose for intravenous aciclovir is 10 mg/kg body weight IV 3 times daily, as recommended by the Centers for Disease Control and Prevention 3
Some experts base IV aciclovir dosing in children over 1 year on body surface area (500 mg/m²/dose IV every 8 hours), according to the Centers for Disease Control and Prevention 2
Aciclovir is classified as Category B in FDA pregnancy rating, and routine use during pregnancy is not generally recommended, as stated by the Centers for Disease Control and Prevention 4
For serious viral-mediated complications during pregnancy, intravenous aciclovir should be considered, according to the Centers for Disease Control and Prevention 4

The Centers for Disease Control and Prevention recommends that aciclovir is not indicated for prophylactic use in healthy individuals after exposure to varicella 4
For susceptible immunocompromised patients, zoster immune globulin within 96 hours of exposure is recommended rather than aciclovir, as stated by the Centers for Disease Control and Prevention 6
A 7-day course of aciclovir starting 7 days after exposure may be considered for those without access to vaccination who are exposed to chickenpox, according to the World Health Organization 7

Aciclovir does not eradicate latent virus or affect subsequent risk, frequency, or severity of recurrences, as stated by the Centers for Disease Control and Prevention 5
Antibody titers after infection in children receiving aciclovir do not differ substantially from those not receiving treatment, according to the Centers for Disease Control and Prevention 4