What is the management for chicken pox?

Management of Chickenpox (Varicela)

Antiviral therapy with aciclovir should be initiated as soon as possible, preferably within 24 hours of rash onset, at a dose of 20 mg/kg (maximum 800 mg) 4 times daily for 5-7 days in patients who are at risk for complications. 1, 2

Indications for Antiviral Treatment

• Treatment should be considered for the following high-risk groups:
  • Patients over 12 years of age 2
  • Immunocompromised individuals 2, 1
  • Patients with chronic cutaneous or pulmonary disorders 2
  • Patients receiving long-term salicylate therapy 2
  • Patients receiving corticosteroid therapy 2
  • Secondary household contacts of infected children 2

Dosing Recommendations

Oral Aciclovir

• Children <45 kg: 20 mg/kg (maximum 400 mg/dose) 3-4 times daily for 5-10 days 2
• Adults and adolescents: 800 mg orally 4-5 times daily for 7-10 days 2, 1
• Continue treatment until no new lesions appear for 48 hours 2

Intravenous Aciclovir

• For severe disease or immunocompromised patients: 10 mg/kg IV every 8 hours 1, 2
• Some experts dose by body surface area in children >1 year: 500 mg/m²/dose IV every 8 hours 2

Symptomatic Management

• Maintain adequate hydration 3
• Use acetaminophen (paracetamol) for fever control 4, 5
• Avoid NSAIDs (ibuprofen) due to potential increased risk of severe bacterial skin infections 4, 5
• Topical calamine lotion or antihistamines may help relieve itching 5
• Keep fingernails short and clean to prevent secondary bacterial infection from scratching 5

Special Populations

Immunocompromised Patients

• Require more aggressive treatment with intravenous aciclovir 1, 2
• Immunomodulator therapy should be discontinued in severe cases if possible 6
• Immunomodulator therapy can be reintroduced after all vesicles have crusted over and fever has resolved 6

Post-Exposure Prophylaxis

• Susceptible individuals exposed to chickenpox should receive varicella zoster immune globulin (VZIG) within 96 hours of exposure 6, 1
• If VZIG is unavailable, a 7-day course of aciclovir starting 7-10 days after exposure may be considered 1

Infection Control Measures

• Isolate patients with active chickenpox until all lesions have crusted over 6
• Healthcare workers with no evidence of immunity who are exposed to VZV should receive post-exposure vaccination and be furloughed from days 10-21 after exposure 6
• Healthcare workers with active lesions should avoid contact with susceptible individuals until all lesions resolve 6

Clinical Pearls and Pitfalls

• Early treatment (within 24 hours of rash onset) is crucial for maximizing effectiveness of antiviral therapy 1, 7
• Aciclovir does not eradicate latent virus or affect subsequent risk of herpes zoster 2
• Dosage adjustment is required in patients with renal impairment 3
• Severe complications can include pneumonia, central nervous system infection, and secondary bacterial infections 5
• Symptomatic treatment alone is usually adequate for healthy children with uncomplicated chickenpox 8

Vaccination

• Vaccination is recommended for susceptible individuals but should not be administered to immunocompromised patients due to risk of disseminated viral infection 6
• Household contacts of susceptible immunocompromised individuals should be vaccinated if they are seronegative for HIV and have no history of chickenpox 6

By following these guidelines, most cases of chickenpox can be managed effectively with minimal complications. The key is early recognition and appropriate treatment for those at higher risk of severe disease.