Pediatric Guidelines: Viral Infections - Varicella Zoster Virus

Condition Major Pathogens First Choice Therapy Alternative Therapy Comments
Varicella (primary infection) or herpes zoster (reactivation) in immunocompromised hosts Varicella zoster virus

IV therapy (initial treatment):

Acyclovir 10mg/kg/dose IV q8h


Consider ID consultation

Duration: Dependent on clinical resolution

Oral therapy (step-down):

Acyclovir 20mg/kg/dose (max 800mg/dose) PO - 4x/day for children < 12 years; 5x/day for adolescents >=12 years


Valacyclovir 20mg/kg/dose (max 1000mg/dose) PO TID

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).