Varicella zoster virus infections

Chicken pox

Aciclovir oral 800mg five times daily for 7 days

For cases of chicken pox and shingles in pregnant or immunocompromised adults, seek urgent specialist advice. Pregnant women are at greater risk of varicella pneumonia. There is a risk of congenital varicella syndrome in the first 20 weeks of pregnancy. Severe disease may occur in the neonate if varicella is contracted in the peri-natal period.

Treat adult patients presenting within <24 hours of onset of rash; patients with severe pain, dense/oral rash; secondary household cases, as these are often more severe than the index case; patients on steroids; smokers. Antiviral treatment within 24 hours of rash onset can shorten the duration of fever and reduce number of lesions, but does not reduce the complication rate.

Shingles

Immunocompetent:

Aciclovir oral 800mg five times daily for 7 days

Urgently refer patients presenting in primary care with shingles in the distribution area of the ophthalmic nerve.

For shingles in pregnant adults, seek urgent specialist advice. Severe disease may occur in the neonate if varicella virus is contracted in the peri-natal period.

Immunocompromised:

Aciclovir oral 800mg five times daily continued for 2 days after crusting of lesions

For shingles in immunocompromised adults, seek urgent specialist advice. 

Treat patients presenting within <72hrs of onset of rash, patients >50 years old, those presenting with rash in areas other than the trunk, or with moderate to severe pain or rash. Evidence from randomised controlled trials support treatment with antivirals and appropriate analgesia for all those over 50 years to prevent the incidence of post-herpetic neuralgia.

If the patient presents after >72hrs - 1 week after symptom onset, and is at risk of severe shingles or reports ongoing vesicle formation or severe pain, antiviral treatment should still be considered.