Treatment of Shingles in Children
The treatment of shingles (herpes zoster) in children should include oral acyclovir, administered within 24 hours of rash onset for optimal effectiveness. 1
First-Line Treatment
- Oral acyclovir is the primary treatment for shingles in immunocompetent children, ideally started within 24 hours of rash onset 1
- For moderate to severe cases of shingles in children, the recommended dosage is acyclovir 20 mg/kg body weight (maximum 400 mg/dose) per dose orally 3 times daily for 5-10 days 1
- For more severe cases or immunocompromised children, intravenous acyclovir may be necessary at 10 mg/kg body weight IV 3 times daily 1
Alternative Antiviral Options
- Valacyclovir can be used in older children who can receive adult dosing, though pediatric preparation is limited 1, 2
- Famciclovir is another alternative for older children and adolescents, though like valacyclovir, pediatric dosing data are limited 1
- For acyclovir-resistant cases, foscarnet 40-60 mg/kg body weight IV per dose 3 times daily for 7-10 days is recommended 1
Special Considerations for Immunocompromised Children
- Immunocompromised children are at higher risk for disseminated disease and require more aggressive treatment 1
- HIV-infected children with shingles often require more intensive monitoring and may have more severe or prolonged courses 3
- For immunocompromised children, intravenous acyclovir is often the preferred initial treatment to prevent dissemination 4
Management of Complications
- Pain management is an important component of shingles treatment in children 5
- For postherpetic neuralgia (uncommon in children but possible), treatment options include tricyclic antidepressants or anticonvulsants in low dosages 5, 6
- Ocular involvement requires prompt referral to an ophthalmologist to prevent serious complications 5
Prevention
- No specific preventive measures are currently available for shingles in children who have had chickenpox 1
- For susceptible children (those without history of chickenpox) exposed to varicella, varicella zoster immune globulin (VZIG) should be administered within 96 hours of exposure 1
- HIV-infected children who are asymptomatic and not immunosuppressed may receive live attenuated varicella vaccine at 12-15 months of age or later to prevent primary varicella infection 1
Clinical Pearls and Pitfalls
- Early treatment (within 24 hours of rash onset) is crucial for maximizing the effectiveness of antiviral therapy 1
- Shingles in children is generally milder than in adults, with lower risk of postherpetic neuralgia 7
- Avoid delaying treatment while waiting for laboratory confirmation; diagnosis is typically clinical 5
- Children with shingles are potentially contagious to individuals who have not had chickenpox or been vaccinated against varicella 3
By following these treatment guidelines, most immunocompetent children with shingles will experience resolution of symptoms within 7-10 days, with minimal risk of complications.