Management of Severe and Immunocompromised Herpes Zoster Cases

Severe/Systemic Complications

• Patients with disseminated herpes zoster, encephalitis, or pneumonitis should receive intravenous acyclovir 5–10 mg/kg every 8 hours and be admitted to the hospital for close monitoring, as recommended by the CDC MMWR guidelines. 1

Immunocompromised Patients

• In individuals with compromised immunity, oral acyclovir dosing should be increased to 400 mg three to five times daily, and the total duration of antiviral therapy should be extended beyond the standard 7‑day course, per CDC MMWR recommendations. 3

Topical Antiviral Use

• Topical acyclovir is significantly less effective than oral formulations for treating herpes zoster and should be avoided in clinical practice, according to CDC MMWR guidance. 4