From the Guidelines
Treatment for varicella zoster singles should involve oral antiviral therapy with valacyclovir, famciclovir, or acyclovir, started within 72 hours of rash onset, to reduce viral shedding, hasten healing, and decrease the severity and duration of acute pain. The recommended treatment regimen is valacyclovir (1,000 mg three times daily for 7 days), famciclovir (500 mg three times daily for 7 days), or acyclovir (800 mg five times daily for 7-10 days) 1.
Some key points to consider in the treatment of varicella zoster singles include:
- Starting antiviral therapy within 72 hours of rash onset to maximize its effectiveness 1
- Using oral antiviral medications as the first-line treatment, with intravenous acyclovir reserved for complicated cases, such as multi-dermatomal, ophthalmic, visceral, or disseminated herpes zoster 1
- Considering pain management with acetaminophen, NSAIDs, or short-term opioid analgesics, as well as topical treatments like lidocaine patches or capsaicin cream for localized relief
- Keeping lesions clean and dry to prevent secondary bacterial infections, and using calamine lotion to soothe the rash
It's also important to note that immunosuppressive therapy should be discontinued in severe cases of varicella infection, and antiviral therapy should be prescribed promptly to reduce the risk of complications 1. Overall, the goal of treatment is to reduce the severity and duration of symptoms, prevent complications, and improve quality of life for patients with varicella zoster singles.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Acute Treatment of Herpes Zoster: 800 mg every 4 hours orally, 5 times daily for 7 to 10 days. INDICATIONS AND USAGE Herpes Zoster Infections : Acyclovir tablets is indicated for the acute treatment of herpes zoster (shingles). The treatment for varicella zoster (shingles) is acyclovir (PO) 800 mg every 4 hours orally, 5 times daily for 7 to 10 days 2.
- The dosage regimen is for the acute treatment of herpes zoster.
- Acyclovir tablets are indicated for the acute treatment of herpes zoster (shingles) 2.
From the Research
Treatment Options for Varicella Zoster
- Antiviral therapy is effective in treating acute varicella and herpes zoster 3
- Valaciclovir is a well-tolerated first-line therapy for the treatment of immunocompetent patients with herpes zoster 4
- Combination therapy with valacyclovir, methylprednisolone, and pregabalin has better efficacy compared to valacyclovir and pregabalin and valacyclovir alone in the management of acute herpes zoster neuralgia 5
Medications Used
- Valaciclovir: 1000 mg 3 times daily for 7 days 4, 5
- Aciclovir: 800 mg 5 times daily for 7 days 4, 6
- Pregabalin: 75 mg twice daily for 1 month 5
- Methylprednisolone: 0.64 mg/kg body weight in two divided doses for 7 days 5
- Gabapentin: may reduce the severity of complications when initiated concomitantly with antiviral therapy as soon as the rash develops 3
Prevention
- Herpes zoster vaccine can decrease the burden of illness caused by varicella zoster virus and the incidence of herpes zoster 3, 7
- Vaccination strategies can prevent varicella or shingles 7
Future Perspectives
- New antiviral agents are necessary for the treatment of varicella zoster virus infections 7
- Novel anti-VZV drugs have recently been evaluated in clinical trials, including the bicyclic nucleoside analogue FV-100, the helicase-primase inhibitor ASP2151, and valomaciclovir (prodrug of the acyclic guanosine derivative H2G) 7