What is the treatment for varicella?

From the Guidelines

The primary treatment for varicella is supportive care to manage symptoms while the virus runs its course, with antiviral medications like acyclovir prescribed for severe cases or high-risk individuals, started within 24 hours of rash onset for best effectiveness. Here's a comprehensive approach:

• Rest and isolate: Stay home and avoid contact with others until all blisters have crusted over, typically 5-7 days.
• Manage itching:
  • Take cool baths with colloidal oatmeal
  • Apply calamine lotion to itchy areas
  • Use over-the-counter antihistamines like diphenhydramine (Benadryl) for severe itching
• Reduce fever and discomfort:
  • Take acetaminophen (Tylenol) as needed
  • Avoid aspirin due to risk of Reye's syndrome
• Prevent skin infections:
  • Trim fingernails short
  • Wear mittens at night to prevent scratching
  • Use antiseptic solutions on any scratched areas
• Stay hydrated: Drink plenty of fluids to prevent dehydration For severe cases or high-risk individuals, antiviral medications may be prescribed:

• Acyclovir: 20 mg/kg (up to 800 mg) four times daily for 5 days
• Start within 24 hours of rash onset for best effectiveness, as demonstrated by studies such as 1 and 1, which show the effectiveness of acyclovir in reducing varicella-associated morbidity and mortality. High-dose IV acyclovir remains the treatment of choice for VZV infections in compromised hosts, as stated in 1 and 1.

The use of antiviral medications like acyclovir is supported by studies such as 1, which demonstrates the beneficial clinical effects of acyclovir in treating varicella. Additionally, 1 provides guidelines for the diagnosis and management of skin and soft tissue infections, including varicella, and recommends the use of antiviral medications like acyclovir for severe cases or high-risk individuals.

It's essential to note that vaccination is the best prevention for those who haven't had chicken pox, and recipients of allogeneic blood and bone marrow transplants should take acyclovir (800 mg bid) or valacyclovir (500 mg bid) during the first year following transplant for the prevention of VZV and HSV reactivation, as recommended in 1.

From the FDA Drug Label

Treatment of Chickenpox: Children (2 years of age and older):20 mg/kg per dose orally 4 times daily (80 mg/kg/day) for 5 days. Children over 40 kg should receive the adult dose for chickenpox Adults and Children over 40 kg: 800 mg 4 times daily for 5 days. The treatment for varicella (chickenpox) is acyclovir. The recommended dose is:

• For children (2 years of age and older): 20 mg/kg per dose orally 4 times daily for 5 days
• For children over 40 kg and adults: 800 mg 4 times daily for 5 days 2

From the Research

Treatment for Varicella

The treatment for varicella (chickenpox) depends on the severity of the disease and the individual's immune status.

• For immunocompromised patients, antiviral drugs such as acyclovir are recommended to reduce the risk of severe disease and mortality 3, 4, 5.
• Acyclovir can be administered intravenously for severe cases or orally for less severe cases 4, 5.
• The dosage and administration route of acyclovir depend on the individual's age, weight, and immune status, as well as the severity of the disease 3, 5.
• For healthy individuals with mild varicella, treatment is typically focused on relieving symptoms and preventing complications, rather than using antiviral drugs 3.
• In cases where varicella is severe or occurs in high-risk individuals, such as newborns or immunocompromised patients, hospitalization and intravenous acyclovir may be necessary 6.
• Varicella zoster immune globulin (VZIG) may be used as post-exposure prophylaxis for individuals who are at high risk of severe varicella, such as immunocompromised patients, pregnant women, and newborns 7, 6.

Special Considerations

• For newborns exposed to varicella, VZIG may be administered to reduce the severity of the disease, and intravenous acyclovir may be used in cases of severe disease 6.
• Pregnant women who are non-immune to varicella and are exposed to the virus may receive VZIG to reduce the risk of severe disease 6.
• Preterm infants in the neonatal nursery may receive acyclovir as a preventive measure against varicella 3.