From the Guidelines
The recommended treatment for herpes zoster (shingles) pustules is antiviral medication started within 72 hours of rash onset, with first-line options including oral acyclovir, valacyclovir, or famciclovir. According to the most recent guidelines 1, high-dose IV acyclovir remains the treatment of choice for VZV infections in compromised hosts, while oral acyclovir, famciclovir, and valacyclovir are beneficial for VZV infections in otherwise healthy hosts.
Key Considerations
- Valacyclovir and famciclovir are generally preferred due to better bioavailability and simpler dosing schedules 1.
- For pain management, acetaminophen or NSAIDs can be used initially, with gabapentin, pregabalin, or tricyclic antidepressants added for more severe pain.
- Topical treatments like calamine lotion or colloidal oatmeal baths may provide symptomatic relief.
- It is essential to keep the rash clean and avoid scratching to prevent secondary bacterial infection.
- Patients should also avoid contact with pregnant women, newborns, and immunocompromised individuals until lesions crust over.
Treatment Details
- Oral acyclovir can be administered at a dose of 800 mg five times daily for 7-10 days 1.
- Valacyclovir can be administered at a dose of 1000 mg three times daily for 7 days 1.
- Famciclovir can be administered at a dose of 500 mg three times daily for 7 days 1. Antiviral medications work by inhibiting viral DNA synthesis, reducing viral shedding, accelerating healing, and decreasing the risk of postherpetic neuralgia, which is a common complication of shingles 1.
From the FDA Drug Label
Herpes zoster (shingles):The recommended dosage of famciclovir tablets for the treatment of herpes zoster is 500 mg every 8 hours for 7 days. Herpes Zoster The recommended dosage of VALTREX for treatment of herpes zoster is 1 gram 3 times daily for 7 days
The recommended treatment for herpes zoster (shingles) pustules is:
- Famciclovir: 500 mg every 8 hours for 7 days 2
- Valacyclovir: 1 gram 3 times daily for 7 days 3 Key points:
- Therapy should be initiated as soon as herpes zoster is diagnosed.
- Therapy is most effective when started within 48-72 hours of the onset of rash.
From the Research
Treatment Options for Herpes Zoster Pustules
The recommended treatment for herpes zoster (shingles) pustules includes antiviral medications. Some of the key treatment options are:
- Valaciclovir: a prodrug of aciclovir, which has been shown to be effective in controlling the symptoms of acute herpes zoster and alleviating zoster-associated pain and postherpetic neuralgia faster than aciclovir 4, 5
- Famciclovir: a prodrug of penciclovir, which has been found to be as effective as valaciclovir in speeding resolution of acute herpes zoster rash and shortening the duration of postherpetic neuralgia 4, 6
- Acyclovir: an antiviral drug that is effective in treating herpes zoster, but may have a lower oral bioavailability compared to valaciclovir and famciclovir 7, 8
Dosage and Administration
The dosage and administration of these antiviral medications vary:
- Valaciclovir: 1000 mg three times daily for 7 days 4, 5
- Famciclovir: 500 mg three times daily for 7 days 4, 6
- Acyclovir: 800 mg five times daily for 7 days 8
Efficacy and Safety
These antiviral medications have been shown to be effective and safe in treating herpes zoster:
- Valaciclovir and famciclovir have been found to be more effective than acyclovir in reducing the risk of herpes-zoster-associated pain 6
- Valaciclovir and famciclovir have been shown to be well-tolerated, with similar adverse event profiles to acyclovir 4, 6
- The efficacy and safety of these antiviral medications have been confirmed in various studies, including those in immunocompetent patients and patients with herpes zoster ophthalmicus 4, 7, 5, 6