From the Guidelines
The treatment for Herpes Zoster (shingles) is antiviral therapy, specifically acyclovir, famciclovir, or valacyclovir, which should be administered within 72 hours of rash onset to accelerate the rate of cutaneous healing and reduce the severity of acute pain.
Treatment Options
- Acyclovir: administered orally, with a dose of 800 mg twice per day, or intravenously in high-dose for compromised hosts 1
- Famciclovir: administered orally, with similar efficacy to acyclovir when administered within 72 hours of rash onset 1
- Valacyclovir: administered orally, with a dose of 500 mg twice per day, or used to complete therapy once the patient has shown a clinical response to intravenous acyclovir 1
Patient Considerations
- Immunocompromised hosts: require high-dose intravenous acyclovir, and may need to take oral acyclovir or valacyclovir during the first year after transplantation to prevent VZV and HSV reactivation 1
- Otherwise healthy hosts: can be treated with oral acyclovir, famciclovir, or valacyclovir, but oral therapy should be reserved for mild cases of VZV disease in patients with transient immune suppression or as treatment to complete therapy once the patient has shown a clinical response to intravenous acyclovir 1 The choice of antiviral therapy should be based on the severity of the disease, the patient's immune status, and the potential for antiviral resistance, as investigated by 1.
From the Research
Treatment Options for Herpes Zoster
The treatment for Herpes Zoster (shingles) primarily relies on:
- Antiviral drugs, such as aciclovir, valacyclovir, and famciclovir, which can reduce the duration and intensity of the disease 2, 3, 4
- Immunomodulating agents, specific immunoglobulins, antimicrobial agents, antiviral enzymes, and corticosteroids may also be used in certain cases 2
- Pain management, including topical lidocaine patch, gabapentin, pregabalin, tricyclic antidepressants, or opiates, is crucial for patients with postherpetic neuralgia (PHN) 5, 6, 4
Antiviral Therapy
Antiviral therapy should be initiated within 72 hours of the development of the rash to be effective 3, 4
- Acyclovir, valacyclovir, and famciclovir are the most commonly used oral antiviral agents for the treatment of herpes zoster 3, 4
- These agents can reduce the duration and intensity of zoster-associated pain (ZAP) and provide more rapid skin lesion healing 3
Prevention
The varicella zoster virus vaccine can decrease the incidence of herpes zoster and is approved for adults 50 years and older 4
- The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommends this vaccine for adults 60 years and older, except for certain immunosuppressed patients 4