Treatment of Shingles in Children

First-Line Treatment

The Centers for Disease Control and Prevention recommends oral acyclovir as the primary treatment for shingles in immunocompetent children, ideally started within 24 hours of rash onset 1
For moderate to severe cases of shingles in children, the recommended dosage is acyclovir 20 mg/kg body weight (maximum 400 mg/dose) per dose orally 3 times daily for 5-10 days 2
For more severe cases or immunocompromised children, intravenous acyclovir may be necessary at 10 mg/kg body weight IV 3 times daily 2

Valacyclovir can be used in older children who can receive adult dosing, though pediatric preparation is limited 2
Famciclovir is another alternative for older children and adolescents, though like valacyclovir, pediatric dosing data are limited 2
For acyclovir-resistant cases, foscarnet 40-60 mg/kg body weight IV per dose 3 times daily for 7-10 days is recommended 2

Immunocompromised children are at higher risk for disseminated disease and require more aggressive treatment 3, 4

No specific preventive measures are currently available for shingles in children who have had chickenpox 3, 5
For susceptible children (those without history of chickenpox) exposed to varicella, varicella zoster immune globulin (VZIG) should be administered within 96 hours of exposure 5
HIV-infected children who are asymptomatic and not immunosuppressed may receive live attenuated varicella vaccine at 12-15 months of age or later to prevent primary varicella infection 5

Early treatment (within 24 hours of rash onset) is crucial for maximizing the effectiveness of antiviral therapy 1

Immunomodulator therapy should not be commenced during active shingles infection and should be discontinued in severe cases if possible, according to the European Crohn’s and Colitis Organisation 6
Immunomodulator therapy can be reintroduced only after all vesicles have crusted over and fever has resolved, as recommended by the European Crohn’s and Colitis Organisation 6