From the Guidelines
The most effective strategy to prevent Herpes zoster (HZ) is through vaccination, specifically with the recombinant zoster vaccine (RZV), which is recommended for immunocompetent adults aged 50 years or older. According to the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices 1, RZV is preferred over the live, attenuated zoster vaccine (ZVL) due to its higher efficacy (96% vs. 70%). The recommendations for HZ vaccination in adults aim to reduce the disease burden of HZ and its complications, such as postherpetic neuralgia 1.
For patients who have already developed Herpes zoster, treatment includes antiviral medications such as acyclovir, valacyclovir, or famciclovir for 7-10 days, which are most effective when started within 72 hours of rash onset. Pain management is also crucial, using medications like acetaminophen, NSAIDs, gabapentin, pregabalin, or tricyclic antidepressants. In severe cases, hospitalization and intravenous acyclovir may be necessary. It is essential to keep the rash clean and covered to prevent spreading the virus to others who haven't had chickenpox.
Key considerations for Herpes zoster management include:
- Vaccination with RZV for prevention in adults aged 50 years or older
- Antiviral medication for treatment, started within 72 hours of rash onset
- Pain management using a variety of medications
- Keeping the rash clean and covered to prevent transmission
- Avoiding contact with pregnant women, newborns, and immunocompromised individuals until lesions have crusted over, as suggested by general principles of infection control, although not directly mentioned in 1 or 1.
The guidance for HZ vaccination is intended for first-line healthcare providers and does not supersede clinical judgment when assessing risk and providing recommendations to individuals 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. Therapy should be initiated as soon as herpes zoster is diagnosed. The recommended treatment for Herpes zoster is famciclovir 500 mg every 8 hours for 7 days, and therapy should be initiated as soon as Herpes zoster is diagnosed 2.
- Key points:
- Dosage: 500 mg every 8 hours
- Duration: 7 days
- Initiation: as soon as Herpes zoster is diagnosed
From the Research
Treatment Options for Herpes Zoster
The recommended treatment for Herpes zoster includes antiviral medications such as acyclovir, valacyclovir, and famciclovir. These medications can help reduce the severity and duration of symptoms, as well as the risk of postherpetic neuralgia (PHN) 3, 4, 5.
Antiviral Medications
- Acyclovir: 800 mg five times daily for 7 days is an effective treatment for herpes zoster 5, 6.
- Valacyclovir: 1000 mg three times daily for 7 days is at least as effective as acyclovir in controlling symptoms and reducing the risk of PHN 4.
- Famciclovir: 500 mg three times daily for 7 days is an effective treatment for acute herpes zoster and can reduce the duration of PHN 3, 5.
Timing of Treatment
Early treatment is most effective in reducing the severity and duration of symptoms 7, 6. Treatment should be started as soon as possible after symptoms appear, ideally within 72 hours of rash onset 4, 7.
Additional Considerations
- Corticosteroids, such as prednisolone, may be used in addition to antiviral medications to reduce inflammation and pain, but their use is controversial and should be individualized 6.
- Treatment regimens may vary depending on the patient's age, immune status, and other factors, and should be determined on a case-by-case basis 5, 7.