Should varicella (chickenpox) in adults be treated with antiviral medications?

From the Guidelines

Yes, chicken pox (varicella) in adults should typically be treated with antiviral medications, as this approach has been shown to reduce the severity and duration of symptoms, as well as decrease the risk of complications, as indicated in the most recent guidelines 1. The recommended antiviral is acyclovir, usually prescribed at 800 mg five times daily for 7-10 days. Alternative antivirals include valacyclovir (1000 mg three times daily for 7 days) or famciclovir (500 mg three times daily for 7 days).

Key Considerations

• Treatment should ideally begin within 24-72 hours of rash onset for maximum effectiveness, as supported by clinical trials among adolescents and adults 1.
• Adults are at higher risk for complications from chicken pox compared to children, including pneumonia, encephalitis, and secondary bacterial infections.
• Antivirals work by inhibiting viral DNA replication, which reduces the severity and duration of symptoms, decreases the risk of complications, and shortens the contagious period.

Supportive Care

• In addition to antivirals, supportive care includes:
  • Acetaminophen for fever (avoid aspirin due to risk of Reye's syndrome)
  • Antihistamines for itching
  • Proper skin hygiene
  • Isolation until lesions have crusted over

Special Considerations

• Pregnant women, immunocompromised individuals, and those with severe disease may require hospitalization and intravenous antiviral therapy, as high-dose IV acyclovir remains the treatment of choice for VZV infections in compromised hosts 1.
• 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.

From the FDA Drug Label

Adults and Children over 40 kg: 800 mg 4 times daily for 5 days. When therapy is indicated, it should be initiated at the earliest sign or symptom of chickenpox.

• Treatment of chickenpox in adults with antivirals, such as acyclovir, is recommended.
• The recommended dosage for adults is 800 mg 4 times daily for 5 days.
• Therapy should be initiated at the earliest sign or symptom of chickenpox 2.

From the Research

Treatment of Chicken Pox in Adults with Antivirals

• The use of antiviral therapy in adults with chicken pox is a topic of discussion among medical professionals, with some studies suggesting its effectiveness in reducing the severity of the disease 3, 4.
• A study published in 2012 found that antiviral therapy was initiated in 13.5% of adult patients with chicken pox, with acyclovir being the most commonly used antiviral drug 5.
• Another study published in 2008 recommended the use of antiviral therapy in adults with chicken pox, particularly those who are at high risk of complications, such as immunocompromised individuals 3.
• A systematic review published in 2015 found that antiviral therapy, specifically aciclovir, was effective in reducing the severity of chicken pox in healthy adults and children, as well as in immunocompromised individuals 6.
• The use of antiviral therapy in adults with chicken pox is generally recommended when started within 24 hours of the onset of rash, and may be considered in certain cases, such as in immunocompromised individuals or those with severe disease 4.

Effectiveness and Safety of Antiviral Therapy

• The effectiveness and safety of antiviral therapy in adults with chicken pox have been evaluated in several studies, with most finding that antiviral therapy is effective in reducing the severity of the disease and preventing complications 3, 6, 4.
• Aciclovir is the most commonly used antiviral drug for the treatment of chicken pox, and has been found to be safe and effective in most cases 5, 4.
• However, the use of antiviral therapy in adults with chicken pox may not be necessary in all cases, and the decision to use antiviral therapy should be made on a case-by-case basis, taking into account the severity of the disease and the individual's underlying health status 3, 4.

Guidelines for Treatment

• The treatment of chicken pox in adults with antivirals is guided by several factors, including the severity of the disease, the individual's underlying health status, and the presence of any complications 3, 4.
• The use of antiviral therapy in adults with chicken pox is generally recommended in cases where the disease is severe, or where the individual is at high risk of complications, such as immunocompromised individuals 3, 4.
• The decision to use antiviral therapy in adults with chicken pox should be made in consultation with a healthcare professional, and should take into account the individual's specific needs and circumstances 3, 4.