Treatment of Varicella Zoster Infections
Introduction to Treatment Recommendations
- The American College of Physicians and Infectious Diseases Society of America recommend oral acyclovir, valacyclovir, or famciclovir as first-line treatments for uncomplicated herpes zoster, while intravenous acyclovir is recommended for severe or disseminated disease 1, 2
Treatment Recommendations Based on Clinical Presentation
- For uncomplicated herpes zoster, the Infectious Diseases Society of America recommends treatment with oral acyclovir or valacyclovir until all lesions have scabbed 1
- For disseminated or invasive herpes zoster, the Kidney International guidelines recommend treatment with intravenous acyclovir, with temporary reduction in immunosuppressive medication if applicable, and continuation of treatment until all lesions have scabbed 1, 2
- The Clinical Infectious Diseases guidelines suggest considering switching to oral therapy once clinical response is observed in patients with disseminated or invasive herpes zoster 2
Special Populations
- For immunocompromised patients, the Clinical Infectious Diseases guidelines recommend high-dose intravenous acyclovir as the treatment of choice, with oral therapy reserved for mild cases or to complete therapy after clinical response to IV treatment 2, 3
- For kidney transplant recipients with uncomplicated herpes zoster, the Kidney International guidelines recommend oral acyclovir or valacyclovir until all lesions have scabbed 1
- For HIV-infected individuals, the Annals of Internal Medicine and MMWR Recommendations and Reports guidelines state that there are no specific differences in treatment recommendations compared to immunocompetent hosts, but may require longer treatment duration and slower healing should be expected 2, 4, 5
Prevention Strategies
- For susceptible individuals after exposure to active VZV infection, the Kidney International and Annals of Internal Medicine guidelines recommend varicella zoster immunoglobulin within 96 hours of exposure, or a 7-day course of oral acyclovir begun 7-10 days after exposure if immunoglobulin is not available 1, 4
- The Annals of Internal Medicine, MMWR Recommendations and Reports, and other guidelines state that no drug has been proven to prevent the recurrence of shingles in immunocompromised or HIV-infected persons 4, 5, 6