What is the recommended treatment for chicken pox?

Treatment of Chicken Pox (Varicella)

For uncomplicated chicken pox in healthy individuals, treatment includes supportive care with oral acyclovir 800 mg 4 times daily for 5 days in adults and 20 mg/kg 4 times daily for 5 days in children, initiated within 24 hours of rash onset. 1

Treatment Approach Based on Patient Population

Healthy Children and Adults

• Supportive care:

  • Hygiene measures to prevent secondary bacterial infection
  • Regular bathing
  • Frequent change of bedding
  • Light, non-irritating clothing
  • Maintain in well-ventilated room
  • Antipyretics for fever (avoid aspirin in children due to Reye's syndrome risk)
  • Antihistamines for itching

• Antiviral therapy:

  • Children (2 years and older): Acyclovir 20 mg/kg orally 4 times daily (80 mg/kg/day) for 5 days 1
  • Adults and children >40 kg: Acyclovir 800 mg orally 4 times daily for 5 days 1
  • Therapy should be initiated within 24 hours of rash onset for maximum effectiveness

Immunocompromised Patients

• Intravenous acyclovir is indicated for immunocompromised patients with varicella-zoster infections 1
• Consider temporary reduction in immunosuppressive medications in transplant recipients with varicella infection 2
• Continue treatment until all lesions have scabbed 2

Severe or Complicated Disease

• Intravenous acyclovir for:
  • Visceral dissemination (especially liver and brain involvement)
  • Pneumonitis
  • Encephalitis
  • Severe disease in adults
  • Immunocompromised hosts

Post-Exposure Prophylaxis

For susceptible individuals exposed to varicella:

1. Varicella zoster immunoglobulin (VZIG) within 96 hours of exposure for:

   • Immunocompromised individuals 2
   • Susceptible pregnant women 2
   • Neonates whose mothers develop varicella around delivery

2. Varicella vaccination for post-exposure prophylaxis:

   • Effective if given within 3-5 days of exposure 2
   • Can prevent illness or modify disease severity 2
   • Recommended for susceptible persons following exposure to varicella 2

3. If VZIG is unavailable or >96 hours have passed:

   • Consider a 7-day course of oral acyclovir begun 7-10 days after exposure 2

Special Considerations

Healthcare Workers

• Healthcare workers with varicella should be placed on sick leave immediately 2
• Unvaccinated healthcare workers without immunity who are exposed should:
  • Be furloughed during days 10-21 after exposure
  • Receive post-exposure vaccination as soon as possible 2

Pregnant Women

• Varicella during pregnancy may lead to severe complications
• VZIG is not contraindicated during pregnancy and should be given to susceptible pregnant women after exposure 2

Prevention

• Varicella vaccine is recommended for all susceptible individuals
• Vaccination requirements for childcare and school entry help reduce disease incidence 2
• Vaccination is effective for outbreak control 2

Common Pitfalls and Caveats

1. Delayed treatment: Antiviral therapy should be initiated within 24 hours of rash onset for maximum effectiveness
2. Underestimating severity in adults: Varicella is often more severe in adults than children, with higher risk of complications including pneumonia
3. Missing immunocompromised status: Always assess immune status as management differs significantly
4. Aspirin use in children: Avoid aspirin in children with varicella due to risk of Reye's syndrome
5. Inadequate isolation: Patients are contagious until all lesions have crusted over

The treatment of chicken pox should be tailored based on age, immune status, and disease severity, with prompt initiation of antiviral therapy in high-risk individuals to reduce morbidity and mortality.