From the Guidelines
Varicella (Chickenpox) Diagnosis and Treatment Varicella, also known as chickenpox, is a highly contagious viral infection caused by the varicella-zoster virus 1. The diagnosis of varicella is typically based on the presence of a characteristic rash, fever, and malaise.
Treatment
Treatment for varicella typically involves:
- Symptomatic relief with antipyretics such as acetaminophen (10-15 mg/kg/dose every 4-6 hours) and antihistamines like diphenhydramine (1-2 mg/kg/dose every 6-8 hours) for itching 1.
- In certain cases, antiviral medication such as acyclovir (20 mg/kg/dose four times daily for 5 days) may be prescribed to reduce the severity and duration of symptoms, particularly in high-risk individuals 1. Some key points to consider:
- High-dose IV acyclovir remains 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 of viral reactivation with oral acyclovir, famciclovir, or valacyclovir is an important component of the treatment of cutaneous VZV infection, particularly in high-risk patients during the period of maximum immunosuppression 1.
From the FDA Drug Label
Treatment of Chickenpox: Children (2 years of age and older):20 mg/kg per doseorally 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 in otherwise healthy children is usually a self-limited disease of mild to moderate severity. Adolescents and adults tend to have more severe disease Treatment was initiated within 24 hours of the typical chickenpox rash in the controlled studies, and there is no information regarding the effects of treatment begun later in the disease course.
The diagnosis of Varicella (chickenpox) is typically based on the presence of a characteristic rash and symptoms such as fever and malaise. The treatment for chickenpox with acyclovir is as follows:
- For children (2 years of age and older): 20 mg/kg per dose orally 4 times daily for 5 days
- For children over 40 kg and adults: 800 mg 4 times daily for 5 days Treatment should be initiated within 24 hours of the onset of the chickenpox rash 2.
From the Research
Diagnosis of Varicella (Chickenpox)
- The diagnosis of varicella is typically made by history and physical examination, with laboratory confirmation required for atypical cases 3.
- Laboratory confirmation can be achieved through virus/viral antigen detection, virus isolation and identification, or serological diagnosis (detection of specific anti-VZV antibodies in patient's sera) 3.
- In cases of suspected central nervous system (CNS) involvement, examination of cerebrospinal fluid (CSF) may be necessary to diagnose VZV-induced neurological disease 4.
Treatment of Varicella (Chickenpox)
- Treatment for varicella typically involves supportive care, such as hydration, rest, and antipyretics, with the goal of managing symptoms and preventing complications 5.
- Antiviral agents, such as acyclovir, may be indicated for individuals with severe forms of varicella or those at high risk of complications, including adults, immunocompromised patients, and those with viral complications 3.
- In cases of disseminated VZV infection or CNS involvement, treatment with intravenous acyclovir and/or oral prednisone may be necessary 6.
- Immunocompromised patients may require intravenous acyclovir, while oral antiviral drugs can speed healing of rash and shorten acute pain in immunocompetent patients 4.
Prevention of Varicella (Chickenpox)
- Prevention of varicella includes active and passive immunization, with a live, attenuated vaccine available for seronegative immunodeficient children and other high-risk individuals 3.
- Varicella-immunoglobulin (VZIG) can be used for passive immunization in certain situations, such as post-exposure prophylaxis for high-risk individuals 7.
- Hygiene measures, including isolation, bathing, and use of stringent soaks, can help prevent secondary bacterial skin infections and reduce the risk of transmission 3.