From the Guidelines
The treatment cycle for herpes zoster (shingles) typically involves antiviral therapy for a duration of 7-14 days in immunocompromised hosts and 4-6 days in otherwise healthy hosts, with the entire disease duration being approximately 2 weeks 1.
Treatment Options
- High-dose IV acyclovir is the treatment of choice for VZV infections in compromised hosts 1.
- Oral acyclovir, famciclovir, and valacyclovir are beneficial for VZV infections in otherwise healthy hosts, 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 IV acyclovir 1.
Prevention
- Recipients of allogeneic blood and bone marrow transplants routinely take acyclovir (800 mg bid) or valacyclovir (500 mg bid) during the first year following transplant for the prevention of VZV and HSV reactivation 1.
Disease Duration
- Lesions in otherwise healthy hosts continue to erupt for at least 4-6 days, with the entire disease duration being approximately 2 weeks 1.
- Among immunocompromised hosts, skin lesions may continue to develop over a longer period (7-14 days) and generally heal more slowly unless effective antiviral therapy is administered 1.
From the Research
Treatment Overview
The treatment cycle for herpes zoster (shingles) typically involves antiviral medications, such as acyclovir, valacyclovir, or famciclovir, which should be started within 72 hours of the development of the rash 2, 3, 4, 5.
Antiviral Medications
- Acyclovir: taken 5 times daily for 7 days 3
- Famciclovir: taken 3 times daily for 7 days 3
- Valacyclovir: taken 3 times daily, with plasma levels of acyclovir equivalent to those seen following intravenous administration of acyclovir 3
Additional Treatments
- Corticosteroids: may be used to alleviate acute pain, but their effect on postherpetic neuralgia (PHN) is not consistent 3, 4
- Topical lidocaine or capsaicin: may be used to control PHN 2, 5
- Oral gabapentin, pregabalin, or tricyclic antidepressants: may be used to control PHN 2, 5
- Transcutaneous electrical nerve stimulation (TENS): may be a safe adjunct or alternative to antiviral drugs for treatment of acute herpes zoster and prevention of PHN 6
Prevention
- Varicella zoster virus vaccine: decreases the incidence of herpes zoster and is approved for adults 50 years and older 2, 5
- The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommends the vaccine for adults 60 years and older, except for certain immunosuppressed patients 2