From the Guidelines
Discharge precautions for a patient with herpes zoster (shingles) should prioritize preventing transmission of the varicella-zoster virus to susceptible individuals, especially pregnant women, newborns, and immunocompromised individuals, by avoiding direct contact and covering the rash completely until all lesions have crusted over, typically 7-10 days after rash onset. When managing a patient with shingles, it is crucial to consider the potential for transmission and the importance of antiviral therapy, as seen in a case where an 89-year-old man was prescribed acyclovir 800 mg orally five times daily for seven days and gabapentin 300 mg orally three times daily 1. Key precautions include:
- Avoiding direct contact with people who have not had chickenpox or the chickenpox vaccine
- Covering the rash completely with clothing or bandages
- Washing hands frequently, especially after touching the affected areas
- Avoiding scratching the rash to prevent secondary bacterial infections and further viral spread
- Continuing antiviral medications as prescribed, such as acyclovir 800 mg five times daily
- Managing pain with medications as directed, which may include acetaminophen, NSAIDs, or gabapentin for neuropathic pain, as in the case of the 89-year-old man who was prescribed gabapentin 300 mg orally three times daily 1. It is essential to keep the rash clean and dry and apply prescribed topical medications if recommended, all while emphasizing the importance of these precautions to prevent the transmission of the varicella-zoster virus to susceptible individuals.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Discharge Precautions for Herpes Zoster (Shingles)
- The primary concern for discharge precautions is to prevent the spread of the varicella-zoster virus to susceptible individuals, such as children and immunocompromised patients 2.
- Patients with herpes zoster should be advised to avoid contact with individuals who have not had chickenpox or have weakened immune systems until the rash has crusted over 3.
- It is essential to educate patients on proper wound care and hygiene to prevent secondary bacterial infections 2.
- Patients should be informed about the potential for postherpetic neuralgia and the importance of seeking medical attention if they experience persistent pain or other complications 4, 5.
- Discharge instructions should include information on antiviral medication, pain management, and follow-up care to monitor for potential complications 4, 6.
Prevention of Herpes Zoster and Postherpetic Neuralgia
- Vaccination is the most effective strategy for preventing herpes zoster and postherpetic neuralgia, and it is recommended for most adults 60 years and older 3, 6.
- Antiviral therapy, such as acyclovir, famciclovir, or valacyclovir, can decrease the duration of the rash and may reduce the risk of postherpetic neuralgia 4, 5, 6.
- Adjunct medications, including opioid analgesics, tricyclic antidepressants, or corticosteroids, may relieve the pain associated with acute herpes zoster 6.