Chickenpox Treatment Guidelines

Indications for Antiviral Treatment

The American Academy of Pediatrics recommends acyclovir therapy for adolescents and adults ≥13 years of age 1
The Centers for Disease Control and Prevention suggests that immunocompromised patients require intravenous acyclovir 1
The American Academy of Pediatrics recommends acyclovir therapy for children with chronic cutaneous or pulmonary disorders 1
The American Academy of Pediatrics recommends acyclovir therapy for patients receiving long-term salicylate therapy 1
The American Academy of Pediatrics recommends acyclovir therapy for patients on corticosteroid therapy 1

The American Academy of Pediatrics recommends oral acyclovir 20 mg/kg per dose (maximum 800 mg) orally 4 times daily for 5 days for children <40 kg 1
The American Academy of Pediatrics recommends oral acyclovir 800 mg orally 4 times daily for 5 days for adults and children >40 kg 1
The Centers for Disease Control and Prevention recommends intravenous acyclovir 10 mg/kg every 8 hours for 7-10 days for severe disease or immunocompromised patients 2, 3, 1

The Centers for Disease Control and Prevention recommends varicella zoster immune globulin (VZIG) as soon as possible, up to 10 days after exposure, for susceptible immunocompromised patients 2, 3, 1
The Centers for Disease Control and Prevention recommends oral acyclovir 10 mg/kg four times daily for 7 days, starting 7-10 days after exposure, if VZIG is unavailable 2, 3, 7, 1
The Centers for Disease Control and Prevention recommends VZIG for pregnant women without evidence of immunity 4, 6
The Centers for Disease Control and Prevention recommends VZIG for neonates born to mothers with varicella 5 days before to 2 days after delivery 4
The Centers for Disease Control and Prevention recommends VZIG for premature infants <28 weeks gestation or <1,000 g regardless of maternal immunity 4

The American Academy of Pediatrics recommends isolating patients until all lesions have crusted over 1
The Centers for Disease Control and Prevention recommends furloughing healthcare workers without immunity exposed to VZV for days 10-21 after exposure 8, 1

The American Academy of Pediatrics recommends against relying on antibody titers in patients with nephrotic-range proteinuria or receiving IVIG, as they are unreliable 2, 3
The Centers for Disease Control and Prevention recommends against administering live varicella vaccine to immunocompromised patients, due to the risk of disseminated infection 5, 1

The Centers for Disease Control and Prevention recommends vaccinating susceptible household contacts of immunocompromised patients to prevent transmission 5, 1
The Centers for Disease Control and Prevention recommends varicella vaccination for HIV-infected children who are asymptomatic and not immunosuppressed at 12-15 months 5
The Centers for Disease Control and Prevention recommends delaying varicella vaccination 5 months after VZIG administration 4