Varicella Zoster Virus

Varicella zoster virus 

Treatment is not routinely recommended in otherwise healthy children with varicella due to the self-resolving nature of infection and short window of viral replication (<72 hours from onset of rash)  

Consider treatment early in disease course in patients at increased risk for moderate to severe varicella based on one or more of the following criteria:  

Age> 12 years old not immunized against VZV 

Chronic cutaneous or pulmonary disorder 

Receiving long term salicylate therapy  

Receiving short or intermittent courses of  systemic corticosteroids 

See 2nd column for treatment indications 

Outpatient/enteral therapy for patients at increased risk:  

Acyclovir
20 mg/kg/dose (max 800 mg/dose) enterally four times daily 

OR 

Valacyclovir using dose below if patient is able to take pills 

IV therapy for patients requiring hospitalization due to varicella: 

Acyclovir
10 mg/kg/dose IV q8h 

ID consult recommended for patients hospitalized due to varicella or related complications  

Duration: 5 days for outpatient therapy, individualized based on response for hospitalized patients but usually 7-10 days similar to below for immuno-compromised patients 

Varicella zoster virus 

As with varicella there is a short window of viral replication (<72 hours from onset of rash); treatment is recommended if it can be initiated within this window or > 72 hours but patient presents with ongoing appearance of new lesions 

Valacyclovir
20 mg/kg/dose (max 1000 mg/dose) enterally tid 

(preferred if patient able to take pills) 

OR  

Acyclovir
20 mg/kg/dose (max 800 mg/dose) enterally four times daily 

(if patient unable to take pills or otherwise to access valacyclovir) 

Varicella zoster virus infection in immuno-compromised hosts 

Includes manifestations of varicella (primary infection) or herpes zoster (reactivation) 

Varicella zoster virus 

IV therapy: 

Acyclovir
10 mg/kg/dose IV q8h 

Enteral therapy:* 

Valacyclovir
20 mg/kg/dose (max 1000 mg/dose) enterally tid 

(preferred if patient able to take pills) 

OR  

Acyclovir
20 mg/kg/dose (max 800 mg/dose) enterally four times daily 

(if patient unable to take pills or otherwise to access valacyclovir) 

Consider ID consultation 

Duration: Antiviral therapy is typically given for 7-10 days or until lesions have crusted over  

*Therapy may be initiated enterally in  patients >= 2 yo with localized herpes zoster, without herpes zoster ophthalmicus or oticus, and without severe symptoms. For patients not meeting these criteria, initiation with IV therapy is recommended, with transition to enteral when the patient shows clinical improvement (no new lesions are appearing)