Initial management of adults with uncomplicated herpes zoster

IV: intravenously; PO: orally.

* There is no specific age cut off to decide when someone who presents after 72 hours may benefit from treatment. However, immunity to varicella-zoster virus (VZV) wanes with increasing age and can be severely impaired in those of advanced age.

¶ For nonpregnant patients who warrant oral therapy, we prefer treatment with valacyclovir or famciclovir because of their lower dosing frequency compared with acyclovir. For pregnant patients, we prefer acyclovir since there is the most experience with this medication in pregnancy. Treatment should continue until all lesions have crusted (typically 7 days for immunocompetent patients; 7 to 14 days for immunocompromised patients).

Δ For patients at high risk for dissemination, we initiate intravenous acyclovir. Patients can switch to an oral agent after clinical improvement; treatment should continue until all lesions have crusted (typically 7 to 14 days).