From the Guidelines
The recommended duration of acyclovir therapy for Varicella (Chickenpox) is 7-10 days or until clinical resolution is attained. When treating Varicella with acyclovir, the dosage is typically 200 mg orally 5 times a day 1. Key considerations for treatment include:
- Initiating treatment as soon as possible after symptom onset to maximize efficacy
- Monitoring for clinical resolution to determine the end of treatment
- Potential adjustments to treatment duration based on individual patient response The goal of acyclovir therapy in Varicella is to reduce the severity and duration of symptoms, and treatment for 7-10 days or until clinical resolution is attained is supported by the available evidence 1. In clinical practice, it is essential to balance the potential benefits of extended treatment with the risks of adverse effects and the development of antiviral resistance. However, based on the current evidence, a treatment duration of 7-10 days or until clinical resolution is attained is the recommended approach 1.
From the FDA Drug Label
Treatment of Chickenpox: Children (2 years of age and older):20 mg/kg per dose orally 4 times daily (80 mg/kg/day) for 5 days. Children over 40 kg should receive the adult dose for chickenpox Adults and Children over 40 kg: 800 mg 4 times daily for 5 days. The duration of therapy for Acyclovir in the treatment of Varicella (Chickenpox) is 5 days 2.
- For children (2 years of age and older) the dose is 20 mg/kg per dose orally 4 times daily.
- For children over 40 kg and adults, the dose is 800 mg 4 times daily.
From the Research
Duration of Acyclovir Therapy for Varicella
The duration of therapy for Acyclovir in the treatment of Varicella (Chickenpox) can vary based on several factors, including the timing of initiation and the patient's age and health status.
- A study published in 2001 3 found that 5 days of therapy is sufficient for immunocompetent children, adolescents, and adults with chickenpox, as a 7-day course provided no additional benefit.
- Another study from 1995 4 treated immunocompetent children with Acyclovir for a duration that was not explicitly stated, but the dosage was 80 mg/kg/daily in 4 divided doses.
- A 1983 study 5 on immunosuppressed patients used Acyclovir for 5 days in herpes simplex and 10 days in herpes zoster and chicken pox.
- The American Academy of Pediatrics Committee on Infectious Diseases stated in 1993 6 that oral acyclovir therapy initiated within 24 hours of illness for otherwise healthy children with varicella typically results in a reduction of symptoms, but the duration of therapy was not specified.
- A randomized, placebo-controlled trial published in 1992 7 treated adults with varicella using oral acyclovir for 7 days, with early treatment (initiated within 24 hours of rash onset) showing a significant reduction in the time to cutaneous healing and duration of fever.
Key Findings
- The optimal duration of Acyclovir therapy for Varicella appears to be around 5-7 days, depending on the patient's health status and the timing of initiation.
- Early treatment, initiated within 24 hours of rash onset, is more effective in reducing the severity and duration of symptoms.
- The dosage and duration of therapy may vary based on the patient's age, weight, and health status.