From the Guidelines
The recommended treatment for herpes zoster in a child is acyclovir, 20 mg/kg body weight orally per dose (max 800 mg/dose) 4 times daily for 7--10 days or until no new lesions for 48 hrs. This treatment is based on the guidelines for the prevention and treatment of opportunistic infections among HIV-exposed and HIV-infected children, which recommends acyclovir as the preferred therapy for herpes zoster in children 1.
Key Considerations
- The treatment should be started as soon as possible, ideally within 72 hours of rash onset, to maximize effectiveness.
- The dosage of acyclovir is crucial, with a maximum of 800 mg per dose, to ensure safety and efficacy.
- For children with severe immune suppression, intravenous acyclovir may be considered, and involvement of an experienced ophthalmologist is strongly recommended for management of varicella zoster virus retinitis 1.
Additional Measures
- Pain management is important, and can be achieved with acetaminophen or ibuprofen for mild pain.
- Keeping the rash clean and dry, avoiding scratching, and considering loose-fitting clothing can help prevent secondary bacterial infections and minimize irritation.
- Children with herpes zoster should be isolated from high-risk individuals until lesions crust over.
Alternative Therapies
- Famciclovir may be considered for older children who can receive adult dosing, although no pediatric preparation is available and data on dosing in children are limited 1.
From the Research
Herpes Zoster Treatment in Children
The recommended treatment for herpes zoster in children involves the use of antiviral medications.
- Acyclovir is often considered the drug of choice for treating varicella and herpes zoster in children, with the route of administration depending on the child's immunocompetence 2.
- The clinical impact of acyclovir therapy is directly related to its early use in the clinical course and the patient's susceptibility to severe or life-threatening VZV infection 2.
- Other antiviral agents like valaciclovir and famciclovir may also be effective in treating herpes zoster, with valaciclovir offering simpler dosing and a favorable safety profile 3, 4.
Antiviral Medications
The choice of antiviral medication and dosage may depend on various factors, including the child's age, immunocompetence, and the severity of the infection.
- A meta-analysis found that 800 mg of acyclovir five times a day, 900-1000 mg of valaciclovir three times a day, and 250 mg of famciclovir three times a day are effective treatment options for herpes zoster 5.
- Valaciclovir and famciclovir have been shown to provide significant reduction in risk of herpes-zoster-associated pain compared to acyclovir, with a more convenient dosing regimen 4.
Treatment Considerations
It is essential to initiate antiviral treatment early in the course of the disease to reduce morbidity and mortality.