What is the treatment for varicella (chickenpox)?

From the Guidelines

Treatment for chicken pox should primarily focus on relieving symptoms, with antiviral medications like acyclovir considered for high-risk individuals or severe cases if started within 24 hours of rash onset, as it has been demonstrated to reduce varicella-associated morbidity and mortality in immunocompromised persons 1. Over-the-counter medications like acetaminophen can help reduce fever and discomfort, but aspirin should be avoided in children due to the risk of Reye's syndrome. For itching, calamine lotion, colloidal oatmeal baths, or oral antihistamines like diphenhydramine can provide relief. It is essential to keep fingernails short and clean to prevent infection from scratching and to stay hydrated and rest until the blisters crust over, typically within 5-10 days. In addition to these measures, cool, loose-fitting clothing and isolation until lesions crust over are crucial to prevent spreading the highly contagious virus to others. According to the recommendations of the advisory committee on immunization practices (ACIP) 1, oral acyclovir has been approved for the treatment of varicella in otherwise healthy children, and its administration within 24 hours of rash onset has been shown to decrease the number of days in which new lesions appear, the duration of fever, and the severity of cutaneous and systemic signs and symptoms. However, the primary consideration should always be the reduction of morbidity, mortality, and improvement of quality of life, particularly in high-risk individuals such as pregnant women, newborns, adults, and immunocompromised people, where antiviral treatment can significantly impact outcomes 1. Key points to consider in the treatment of chicken pox include:

• Relief of symptoms with over-the-counter medications
• Use of antiviral medications like acyclovir in high-risk individuals or severe cases
• Prevention of infection through good hygiene and isolation
• Reduction of morbidity, mortality, and improvement of quality of life as the primary goal of treatment.

From the FDA Drug Label

Treatment of Chickenpox: Children (2 years of age and older):20 mg/kg per dose orally 4 times daily (80 mg/kg/day) for 5 days. Children over 40 kg should receive the adult dose for chickenpox Adults and Children over 40 kg: 800 mg 4 times daily for 5 days. Chickenpox: Chickenpox in otherwise healthy children is usually a self-limited disease of mild to moderate severity. Based on efficacy data from clinical trials with oral acyclovir, treatment with VALTREX should be initiated within 24 hours after the onset of rash

The treatment for chicken pox is acyclovir (PO) with the following dosages:

• Children (2 years of age and older): 20 mg/kg per dose orally 4 times daily for 5 days
• Children over 40 kg and adults: 800 mg 4 times daily for 5 days
• Alternatively, valacyclovir (PO) can be used for the treatment of chickenpox in immunocompetent pediatric patients aged 2 to less than 18 years, initiated within 24 hours after the onset of rash 2, 2, 3.

From the Research

Treatment Options for Chicken Pox

• Intravenous acyclovir is effective for varicella in adults and immunocompromised children, causing more rapid resolution of the illness and fewer complications 4
• Oral acyclovir appears to be effective in varicella and zoster in immunocompromised patients, and also in otherwise normal patients if given early 4
• Topical acyclovir may benefit herpes zoster in immunosuppressed patients by accelerating cutaneous healing 4
• Treatment of chickenpox with oral acyclovir appears to decrease the number of pox lesions and shorten the duration of new lesion formation 5
• Prophylactic intervention with varicella-zoster immunoglobulin early in the incubation period can prevent or attenuate the disease manifestations of varicella in susceptible contacts at high risk from this infection 6
• Intravenous aciclovir therapy for 5-10 days is effective for varicella in neonates and the immunocompromised, and for varicella pneumonia or other complications in adults and children, if begun early 6
• Oral aciclovir is only effective if begun within 24 hours of onset of rash, and is recommended for treatment of varicella in otherwise healthy adults and adolescents, but not for routine use in children under 13 years of age unless they are sibling contacts or have other medical conditions 6
• Valaciclovir, an aciclovir prodrug, is used to treat infections caused by herpes simplex virus and varicella zoster virus, and for prophylaxis against cytomegalovirus 7
• Antiviral treatment of herpesvirus infections, including varicella-zoster virus, is rapidly changing with the advent of new drugs with improved oral availability, such as valaciclovir and famciclovir 8

Dosage and Administration

• Intravenous acyclovir doses of 500 mg/m2 or 10 mg/kg every 8 hours are recommended, with adequate hydration and urine flow, and monitoring of mental status and renal function 4
• Oral acyclovir doses of 800 mg five times a day are recommended 4
• Valaciclovir dosages of ≥ 500 mg daily are recommended for suppression of genital herpes recurrences in immunocompetent individuals 7

Special Considerations

• Acyclovir and vidarabine have not been proven clearly to prevent postherpetic neuralgia 4
• Caution is advised with use of aciclovir in pregnancy 6
• A potentially fatal thrombotic microangiopathy (TMA)-like syndrome has been reported in some immunocompromised patients receiving high-dose prophylactic valaciclovir therapy 7