What treatments are available for varicella (chickenpox) in a pediatric patient?

From the Guidelines

The most effective treatment for varicella (chickenpox) in pediatric patients is prevention through a 2-dose varicella immunization schedule, which has been shown to be 98% effective in preventing any varicella disease and 100% effective in preventing severe disease 1.

Treatment Overview

For children who have already contracted varicella, treatment focuses on managing symptoms and preventing complications.

• Fever and discomfort can be managed with acetaminophen (Tylenol) at a dose of 10-15 mg/kg every 4-6 hours, not exceeding 5 doses in 24 hours.
• Itching can be managed with oral antihistamines like diphenhydramine (Benadryl) at 1-1.5 mg/kg every 6 hours, calamine lotion applied to lesions, or colloidal oatmeal baths.
• Keeping the child's fingernails short and clean, ensuring hydration, and promoting rest are also important aspects of care.

Antiviral Medication

For severe cases or in immunocompromised children, the antiviral medication acyclovir may be prescribed at a dose of 20 mg/kg four times daily for 5 days, with a maximum of 800 mg per dose, if started within 24 hours of rash onset 1.

Monitoring for Complications

It is crucial to monitor for signs of complications, such as high fever, difficulty breathing, severe headache, extreme drowsiness, or a rash that becomes very red, warm, or leaks pus, and to seek medical attention if these symptoms develop.

Postexposure Prophylaxis

For unvaccinated children exposed to varicella, postexposure vaccination within 3 to 5 days of exposure can be effective in preventing or modifying the disease 1. However, the primary strategy should always be prevention through vaccination before exposure occurs.

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. When therapy is indicated, it should be initiated at the earliest sign or symptom of chickenpox.

The available treatment for varicella (chickenpox) in a pediatric patient is acyclovir (PO). The recommended dosage is:

• For children 2 years of age and older: 20 mg/kg per dose orally 4 times daily (80 mg/kg/day) for 5 days
• For children over 40 kg: 800 mg 4 times daily for 5 days Therapy should be initiated at the earliest sign or symptom of chickenpox 2.

From the Research

Treatment Options for Varicella (Chickenpox) in Pediatric Patients

• Acyclovir is a commonly used antiviral medication for the treatment of chickenpox in pediatric patients, as it has been shown to decrease the number of pox lesions and shorten the duration of new lesion formation 3, 4, 5.
• Symptomatic therapy is usually adequate for chickenpox, but in some cases, it may require combinations of antiviral drugs and antibiotics 6.
• The use of corticosteroids in the treatment of chickenpox remains a topic of debate 6.
• Aciclovir and VZIG (varicella zoster immune globulin) may have a role in the management of chickenpox in immunosuppressed or immunodeficient children 7.
• The duration of acyclovir treatment can vary, but 5 days of therapy has been shown to be sufficient, with no additional benefit from a 7-day course 5.

Initiation and Duration of Therapy

• Early initiation of acyclovir treatment, within the first 24 hours of rash onset, is associated with the greatest benefit in reducing the severity and duration of chickenpox 4, 5.
• Delaying treatment until after the first day of rash may reduce the effectiveness of acyclovir 5.

Viral Resistance

• The use of acyclovir in the treatment of chickenpox does not appear to induce viral resistance, as viruses shed during therapy remain susceptible to acyclovir 5.