Management of Shingles with Antiviral Therapy

Special Considerations

• Intravenous antivirals may be necessary for severe cases or immunocompromised patients, as recommended by the Centers for Disease Control and Prevention (CDC) 1
• For acyclovir-resistant cases, intravenous foscarnet or cidofovir can be used, according to the CDC guidelines 1

Special Populations

Immunocompromised Patients

• Intravenous antivirals should be considered for severe cases in immunocompromised patients, as suggested by the CDC 1

Pregnant Women

• VZIG (varicella zoster immune globulin) is recommended for VZV-susceptible pregnant women within 96 hours after exposure to VZV, as recommended by the CDC 2, 3
• If oral acyclovir is used, VZV serology should be performed to determine if the patient is already seropositive, according to the CDC guidelines 2, 3

Children

• The recommendations for preventing initial disease and recurrence in adults generally apply to children as well, as stated by the CDC 2
• HIV-infected children who are asymptomatic and not immunosuppressed should receive live attenuated varicella vaccine at 12-15 months of age or later, as recommended by the CDC 2

Prevention

• No drug has been proven to prevent the recurrence of shingles in HIV-infected persons, as noted by the CDC 2, 3
• Susceptible HIV-infected individuals should avoid exposure to persons with chickenpox or shingles, as advised by the CDC 2, 3

Common Pitfalls and Caveats

• Topical acyclovir is substantially less effective than systemic therapy and is not recommended, according to the CDC 4, 5

Management of Suspected Shingles

Antiviral Therapy

• The Centers for Disease Control and Prevention recommends acyclovir 800 mg orally five times daily for 7-10 days as an antiviral regimen for shingles, ideally initiated within 72 hours of rash onset 6

Special Populations

• The Centers for Disease Control and Prevention recommends VZIG for VZV-susceptible pregnant women within 96 hours after exposure to VZV 7