Analgesia is very important and should be prescribed along with an antiviral
Consider lidocaine patch, NSAIDS, oral opioids, or gabapentin
Diphenhydramine and ranitidine for itch/pain
Reduces risk/duration of postherpetic neuralgia with dosing based on immune status and time course of disease
Not effective in treating postherpetic neuralgia once it has developed
Immunocompetent patients:
Acyclovir 800mg PO 5x/day x 7d if <72hr of onset of rash or >72hr if new vesicles present/developing
Valacyclovir (can also be given but is generally more expensive than acyclovir)
1g PO q8hrs (CrCl normal)
1g PO q12hrs (CrCl 30-49 mL/min)
1g PO q24hrs (CrCl 10-29 mL/min(
500mg q24hrs PO (CrCl < 10ml/min)
1g PO q8hrs (CrCl normal)
1g PO q12hrs (CrCl 30-49 mL/min)
1g PO q24hrs (CrCl 10-29 mL/min(
500mg q24hrs PO (CrCl < 10ml/min)
Immunosuppressed patients:
Antiviral therapy should be given regardless of the time of onset of rash
Acyclovir 10mg/kg IV q8h OR 800mg PO 5x/day x 7d or Foscarnet for acyclovir-resistant VZV, disseminated<unk> , CNS involvement, ophthalmic involvement, advanced AIDS, or recent transplant
Isolation precautions
Disseminated<unk>  requires airborne precautions
Disseminated<unk>  requires airborne precautions
Steroids not shown to be beneficial
Herpes zoster
Febrile
Smallpox
Diffuse distribution
Measles
Varicella
Erythema infectiosum
Disseminated gonococcal disease