What are the anti-viral treatment regimens for varicella-zoster virus (VZV) (chickenpox)?

Updated: Jul 12, 2021
  • Author: Richard Lichenstein, MD; Chief Editor: Thomas E Herchline, MD  more...
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Answer

Answer

Adults with encephalitis, pneumonia, or immunocompromised patients [1] :

Adults and children >12 years at increased risk for complications:

  • Acyclovir 800 mg PO 5 times daily x 5-7 days

  • Valacyclovir 20 mg/kg PO 3 times daily for 5 days; not to exceed 1 g/dose 3 times daily

Children >1 year who have encephalitis or pneumonia or are immunocompromised [4] :

  • Acyclovir 500 mg/m2 IV q8h for 7-10 days

Children 2-12 years who are at increased risk for complications:

  • Acyclovir 20 mg/kg PO 4 times daily for 5 days; not to exceed 3200 mg/day

  • Valacyclovir  20 mg/kg PO 3 times daily for 5 days; not to exceed 1 g/dose 3 times daily 

Children < 1 year who are immunocompromised:

  • 30 mg/kg/day IV in 3 divided doses for 7-10 days

Children 2-12 years with uncomplicated varicella:

  • Use of acyclovir is not routinely recommended

  • Acyclovir use does not affect incidence of pruritus, complications, or secondary transmission in children with varicella

  • Consider acyclovir use in secondary household cases, in which the disease is usually more severe


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