From the Guidelines
The recommended treatment for chicken pox in adults is antiviral therapy with acyclovir, valacyclovir, or famciclovir, which should be started within 24-72 hours of rash onset to reduce symptom severity and duration. For most healthy adults, treatment includes acetaminophen for fever and pain (avoid aspirin due to Reye's syndrome risk), antihistamines like diphenhydramine (25-50mg every 4-6 hours) for itching, and calamine lotion or colloidal oatmeal baths for skin relief 1.
Key Considerations
- Antiviral medication such as acyclovir (800mg five times daily for 7-10 days), valacyclovir (1g three times daily for 7 days), or famciclovir (500mg three times daily for 7 days) is crucial in reducing the severity and duration of the disease.
- Adults should isolate until lesions crust over, maintain good hygiene to prevent secondary infections, stay hydrated, and avoid scratching to prevent scarring.
- High-risk individuals, including pregnant women, immunocompromised individuals, and those with severe disease, may require hospitalization and intravenous antivirals 1.
- Vaccination is recommended for prevention in susceptible adults, especially those in high-risk groups such as healthcare professionals and individuals with compromised immune systems 1.
Special Populations
- Immunocompromised hosts require high-dose IV acyclovir as the treatment of choice for VZV infections, while oral acyclovir, famciclovir, and valacyclovir are beneficial for mild cases in otherwise healthy hosts 1.
- 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 1.
From the FDA Drug Label
Adults and Children over 40 kg: 800 mg 4 times daily for 5 days. The recommended treatment for chicken pox (varicella) in adults is acyclovir (PO) 800 mg 4 times daily for 5 days. Therapy should be initiated at the earliest sign or symptom of chickenpox.
- Key points:
- Dose: 800 mg
- Frequency: 4 times daily
- Duration: 5 days
- Initiation: at the earliest sign or symptom of chickenpox 2
From the Research
Treatment Overview
The recommended treatment for chicken pox (varicella) in adults involves the use of antiviral medications, particularly acyclovir.
- Acyclovir has been shown to reduce the severity and duration of chicken pox in adults when initiated within 24 hours of rash onset 3, 4.
- The treatment typically consists of oral acyclovir, 80 mg/kg/day up to a maximum of 3,200 mg/day in four divided doses, for a duration of 5-7 days 3.
Initiation and Duration of Therapy
- Studies have demonstrated that initiating acyclovir therapy within 24 hours of rash onset is crucial for optimal efficacy 3, 4.
- A 5-day course of acyclovir has been found to be sufficient, with no additional benefit from a 7-day course 3.
- Delaying therapy beyond 24 hours may reduce the effectiveness of acyclovir, although some benefits may still be observed 3, 4.
Special Considerations
- Immunocompromised adults with chicken pox should be treated with intravenous acyclovir as soon as possible to prevent severe complications 4.
- Healthy adults with chicken pox can be treated with oral acyclovir, but the decision to treat should be made on a case-by-case basis, considering factors such as age, health status, and severity of symptoms 4, 5.