Acyclovir Treatment for Chickenpox

Dosing Recommendations

For immunocompetent children aged 2-12 years with chickenpox, the Centers for Disease Control and Prevention recommends administering oral acyclovir 20 mg/kg (maximum 800 mg) four times daily for 5 days, initiated within 24 hours of rash onset for optimal benefit 1, 2
The American Academy of Pediatrics suggests that adolescents and adults should receive 800 mg orally five times daily for 5-7 days 1, 2, 3
For immunocompromised patients, the Infectious Diseases Society of America recommends intravenous acyclovir 10 mg/kg every 8 hours (or 500 mg/m² every 8 hours) for 7-10 days 1, 3, 4

The Centers for Disease Control and Prevention states that acyclovir is FDA Category B with no increased birth defects documented in 596 first-trimester exposures, and consider acyclovir for pregnant women at increased risk for moderate to severe varicella 2, 3, 7
The American College of Obstetricians and Gynecologists recommends varicella-zoster immune globulin (VZIG) within 96 hours of exposure for post-exposure prophylaxis in pregnant women 4, 7

The Centers for Disease Control and Prevention notes that acyclovir does not reduce transmission of varicella 2, 3, 7
The American Academy of Pediatrics states that acyclovir does not reduce duration of school absence 2, 3

The Infectious Diseases Society of America recommends maintaining adequate hydration and monitoring renal function, especially with high-dose therapy 1