When to initiate oral Acyclovir in Chicken Pox (varicella zoster)

TIME

• Most studies carried out/ shows benefit of initiating therapy within the first 24 hours after onset of rash
• In adults, treatment from 25 to 72 hours after the onset showed no effect on the course of illness. Reduction in other complications (such as varicella pneumonia was not studied)

RECOMMENDATIONS:

• To initiate within 24hours of symptom
• Should not be used routinely in otherwise healthy children with varicella due to its modest effect (CDC)

BENEFITS within 24 hours:

• fewer lesions
• accelerated healing
•  shorter duration of fever

HIGH RISK group

• Older children (>12 years)
• Secondary household cases (can be more severe)
• History of chronic cutaneous or cardiopulmonary disorders
• Taking inhaled or intermittent oral steroid
• Taking chronic salicylates (higher risk of developing Reye syndrome)

REFERENCES:

1.       www.uptodate.com