From the Guidelines
The treatment for Herpes Zoster (shingles) is antiviral therapy, specifically high-dose IV acyclovir for compromised hosts and oral acyclovir, famciclovir, or valacyclovir for otherwise healthy hosts.
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
- Acyclovir and famciclovir have been approved by FDA for treating HZ, and if administered within 72 hours of rash onset, they can accelerate the rate of cutaneous healing and reduce the severity of acute pain in adults who have HZ 1
Dosage
- Acyclovir (800 mg bid) or valacyclovir (500 mg bid) can be used for the prevention of VZV and HSV reactivation in recipients of allogeneic blood and bone marrow transplants 1
Important Considerations
- Early treatment is crucial to prevent complications and reduce the severity of the disease
- Immunocompromised patients are at higher risk of developing severe and disseminated disease, and therefore require prompt and effective antiviral therapy 1
From the Research
Treatment Options for Herpes Zoster
The treatment for Herpes Zoster (shingles) primarily relies on antiviral drugs, with the goal of reducing the severity and duration of the disease, as well as preventing complications such as postherpetic neuralgia (PHN) 2, 3, 4.
Antiviral Medications
- Aciclovir is considered a first-line agent for the treatment of herpes zoster, with its efficacy well established by many clinical studies 2.
- Other antiviral medications that have shown efficacy in treating herpes zoster include valacyclovir, famciclovir, and penciclovir 3, 4.
- These medications are most effective when started within 72 hours of the onset of the rash 3, 4.
Pain Management
- Pain relief is an important aspect of managing herpes zoster, with options including acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), opioid analgesics, tricyclic antidepressants, gabapentin, pregabalin, and topical analgesics 5.
- Early treatment with antiviral medications and analgesics can help reduce the incidence and severity of acute zoster pain and PHN 5, 6.
Special Considerations for Immunocompromised Patients
- Immunocompromised patients are at higher risk for complications from herpes zoster, and prompt antiviral therapy is essential to reduce the incidence of cutaneous and visceral dissemination 6.
- Intravenous aciclovir therapy may be necessary for patients with disseminated varicella zoster virus infection, ophthalmic involvement, or severe immunosuppression 6.
- Foscarnet is the drug of choice for treating aciclovir-resistant herpes zoster 6.