From the Guidelines
Treatment for intercostal herpes zoster in adults should start with antiviral therapy as soon as possible, ideally within 72 hours of rash onset, using valacyclovir 1000 mg three times daily for 7 days, famciclovir 500 mg three times daily for 7 days, or acyclovir 800 mg five times daily for 7-10 days, as recommended by the most recent guidelines 1. The goal of treatment is to reduce the severity and duration of symptoms, as well as the risk of postherpetic neuralgia.
- Antiviral medications, such as valacyclovir, famciclovir, and acyclovir, are effective in treating herpes zoster and should be started promptly 1.
- Pain management is also crucial, and can be achieved with acetaminophen or NSAIDs for mild pain, and gabapentin or pregabalin for moderate to severe pain 1.
- Topical lidocaine patches (5%) can provide localized relief, and the rash should be kept clean and dry to prevent secondary bacterial infection.
- Hospitalization may be necessary for immunocompromised patients, those with severe pain, extensive rash, or ophthalmic involvement. The treatment approach should prioritize reducing morbidity, mortality, and improving quality of life, and should be guided by the most recent and highest quality evidence, such as the 2014 update by the Infectious Diseases Society of America 1.
- The choice of antiviral medication and pain management strategy should be individualized based on the patient's specific needs and medical history.
- Early treatment is critical in reducing the risk of complications, such as postherpetic neuralgia, and improving outcomes.
- The treatment guidelines recommend oral acyclovir, famciclovir, and valacyclovir for otherwise healthy hosts, but high-dose IV acyclovir for compromised hosts 1.
From the FDA Drug Label
VALTREX is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults. The efficacy of VALTREX when initiated more than 72 hours after the onset of rash and the efficacy and safety of VALTREX for treatment of disseminated herpes zoster have not been established.
- Intercostal Herpes zoster treatment in adult: Valacyclovir is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults 2.
- Key consideration: The efficacy of valacyclovir when initiated more than 72 hours after the onset of rash has not been established.
- Clinical decision: Valacyclovir can be used to treat intercostal herpes zoster in adults, but initiation of treatment should be within 72 hours of rash onset.
From the Research
Intercostal Herpes Zoster Treatment in Adults
- The treatment of intercostal herpes zoster in adults can be managed with antiviral medications such as valaciclovir, famciclovir, and acyclovir 3, 4, 5, 6, 7.
- Valaciclovir has been shown to accelerate the resolution of herpes zoster-associated pain and offers a simpler dosing regimen compared to acyclovir 3, 7.
- Famciclovir is also effective in the treatment of herpes zoster and has been shown to be comparable to acyclovir in terms of efficacy and safety 4, 5.
- A study comparing famciclovir and valacyclovir found that famciclovir was superior in relieving acute pain in adult Japanese immunocompetent patients with herpes zoster 6.
- The choice of antiviral medication may depend on factors such as the severity of symptoms, patient age, and comorbidities.
Antiviral Medications
- Valaciclovir: 1000 mg three times daily for 7 days 3, 7
- Famciclovir: 250 mg three times daily for 7 days 4, 5, 500 mg twice daily for 7 days 4, or 750 mg once daily for 7 days 4
- Acyclovir: 800 mg five times daily for 7 days 3, 4, 5, 7
Efficacy and Safety
- Valaciclovir and famciclovir have been shown to be effective and safe in the treatment of herpes zoster 3, 4, 5, 6, 7.
- Acyclovir is also effective and safe, but may require more frequent dosing compared to valaciclovir and famciclovir 3, 4, 5, 7.
- The most common adverse events reported with these medications include constipation, headache, nausea, and vomiting 5.