From the Guidelines
For unvaccinated adults with Varicella, the primary treatment focuses on symptom management and preventing complications, with antiviral medication such as acyclovir 800 mg five times daily for 7-10 days, started as soon as possible, preferably within 24 hours of rash onset. To manage symptoms:
- Use calamine lotion or oatmeal baths to relieve itching
- Take acetaminophen for fever and pain (avoid aspirin)
- Stay hydrated and get plenty of rest Prevent spreading the virus by isolating until all lesions have crusted over, typically 5-7 days after rash onset. Avoid scratching to prevent bacterial infections and scarring. Antivirals like acyclovir work by inhibiting viral replication, reducing the severity and duration of symptoms, as noted in the prevention of varicella guidelines 1. However, it's essential to consider that Varicella disease is more severe and its complications more frequent among adolescents and adults, and vaccination is the method of choice for prevention, with two 0.5-mL doses of varicella vaccine administered subcutaneously recommended for adults without evidence of immunity 1. In the context of treatment, while acyclovir is not indicated for prophylactic use among otherwise healthy children, adolescents, or adults without evidence of immunity after exposure to varicella, it is crucial for treating the disease once it occurs, as supported by the guidelines for the use of varicella vaccines and prevention of varicella 1. Given the severity of Varicella in unvaccinated adults and the importance of preventing complications, starting antiviral medication as soon as possible is crucial, and the recommended treatment should prioritize reducing morbidity, mortality, and improving quality of life.
From the FDA Drug Label
Adults and Children over 40 kg: 800 mg 4 times daily for 5 days. The treatment for Varicella in unvaccinated adults is 800 mg of acyclovir 4 times daily for 5 days 2.
From the Research
Treatment for Varicella in Unvaccinated Adults
- The treatment for Varicella in unvaccinated adults typically involves the use of antiviral medications, such as acyclovir, to reduce the severity and duration of the illness 3, 4, 5.
- Acyclovir is approved for the treatment of chickenpox in risk groups, including adults, to reduce the frequency of viral complications and to treat those that have already appeared 3.
- The recommended dosage of acyclovir for adults with chickenpox is 750 mg intravenously three times a day or 800 mg orally five times a day for 7-10 days 3, 5.
- Adequate hydration and urine flow must be maintained during treatment with acyclovir, and impaired renal function requires regulation of dosage downward 5.
- The use of acyclovir in adults with chickenpox has been shown to be effective in reducing the severity and duration of the illness, as well as the risk of complications 4, 6.
- In addition to antiviral medication, treatment for bacterial complications, such as secondary bacterial skin infections, may also be necessary 3.
Considerations for Treatment
- The timing of initiation of acyclovir treatment is important, with earlier treatment being more effective in reducing the severity and duration of the illness 6.
- The duration of treatment with acyclovir is typically 5-7 days, but the optimal duration of treatment may vary depending on the individual patient's response to treatment 6.
- The use of acyclovir in immunocompromised patients, including those with weakened immune systems, requires careful monitoring and adjustment of dosage as needed 5, 7.