From the Guidelines
A second round of antivirals for shingles is not recommended as a standard treatment approach, but it may be considered in certain situations where symptoms persist or worsen, and the first course was inadequate. When considering antiviral treatment for shingles, it's essential to note that the most effective approach is initiating treatment within 72 hours of rash onset, as this can accelerate the rate of cutaneous healing and reduce the severity of acute pain in adults with shingles 1. The standard antiviral medications for shingles include acyclovir, valacyclovir, or famciclovir, with specific dosing regimens such as acyclovir 800 mg five times daily for 7-10 days.
Some key points to consider when evaluating the potential benefit of a second round of antivirals include:
- The mechanism of action of antivirals, which involves inhibiting viral DNA replication, is most effective during the initial phase of the infection.
- Ongoing symptoms may be due to post-herpetic neuralgia rather than active viral replication, in which case antivirals may not be effective, and alternative pain management strategies such as gabapentin, pregabalin, or tricyclic antidepressants may be more appropriate.
- Consultation with a healthcare provider is crucial to determine the best course of action, as they can evaluate the underlying cause of persistent symptoms and recommend the most suitable treatment approach.
In clinical practice, the decision to prescribe a second round of antivirals should be made on a case-by-case basis, taking into account the individual patient's circumstances, the severity of their symptoms, and the potential risks and benefits of additional treatment 1.
From the Research
Antiviral Treatment for Shingles
- The provided studies do not directly address the effectiveness of a second round of antivirals for improving symptoms of shingles 2, 3, 4, 5.
- However, the studies suggest that antiviral medications such as acyclovir, famciclovir, and valacyclovir can be effective in reducing the duration and severity of shingles symptoms when started within 72 hours of rash onset 2, 3, 4.
- One study found that famciclovir reduced the duration of postherpetic neuralgia (PHN) by half compared to placebo 3.
- Another study discussed the management of PHN, including the use of antivirals, corticosteroids, and other treatments, but did not mention the use of a second round of antivirals 4.
- A case report suggested that serial thoracic transforaminal epidural steroid injections can be effective in treating PHN, but this is not directly related to the use of antivirals 6.
- A study on the management of acyclovir-resistant herpes simplex virus discussed treatment protocols, but this is not directly applicable to the treatment of shingles 5.