Chickenpox medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Aravind Reddy Kothagadi M.B.B.S[2]

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## Overview

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There is no definitive treatment for chickenpox, only supportive treatment exists, to minimize discomfort and pruritus. Antiviral therapy with acyclovir and valacyclovir is beneficial if given within the first 24 hours of appearance of the rash.

## Medical Therapy

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### Symptomatic treatment

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* Mild sodium bicarbonate baths, antihistamine medication to help ease itching
* Acetaminophen to reduce fever
* Ibuprofen
* Aspirin must not be given to children with chickenpox to avoid potentially fatal Reye's Syndrome[1][2]
* Maintaining adequate hydration
* Intravenous immunoglobulin therapy is also considered in pregnant women, immunocompromised patients and newborns who are not vaccinated[3]

### Antiviral Therapy

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* Indications for antiviral therapy: [4]

* The decision whether to initiate antiviral therapy in a patient with chickenpox will depend on the patient's age, underlying medical conditions, and the risk of complications.
* In general, young children (under age 12 years) are at lower risk for complications than are adolescents or adults. An exception may be secondary pediatric cases in a household, who tend to have more severe disease than the index case.
* Benefits of antiviral therapy are minimal for healthy children presenting after 24 hours of illness. Because of the greater risk of complications, antiviral therapy is appropriate for adolescents and adults with chickenpox, probably even for those presenting 48–72 hours into the course of illness.
* Immunocompromised patients with varicella are at significant risk for viral dissemination and visceral involvement and should always receive antiviral therapy.

* Antiviral therapy with acyclovir and valacyclovir is beneficial if given within the first 24 hrs of appearance of the rash.[5][6][7]
* Antiviral medications are recommended for people with chickenpox who are more likely to develop serious disease including:
* People with chronic lung or skin disease such as eczema
* People receiving steroid therapy

* Acyclovir, an antiviral medication, is the drug of choice for the treatment of chickenpox. Other antiviral medications that may also work against chickenpox include valacyclovir and famciclovir. It is important to assess the renal function before proceeding with administration of anti-viral therapy for chickenpox.
* Preferred regimen: Acyclovir 20 mg per kg q6h for age groups of 2 to 12 years and adolescents (dose not to exceed 800 mg per day)[7]
* Alternate regimen: Valacyclovir 20 mg per kg q8h for 5 days (dose not to exceed 1000 mg per day)

##### Medications to avoid

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* Aspirin

## References

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1. ↑ US Centers for Disease Control and Prevention. "Varicella Treatment Questions & Answers". CDC Guidelines. CDC. Retrieved 2007-8-23. Check date values in: `|accessdate=` (help)
2. ↑ Somekh E, Dalal I, Shohat T, Ginsberg GM, Romano O (2002). "The burden of uncomplicated cases of chickenpox in Israel". J. Infect. 45 (1): 54–7. PMID 12217733.CS1 maint: Multiple names: authors list (link)
3. ↑ Evans, E.B.; Pollock, T.M.; Cradock-Watson, J.E.; Ridehalgh, M.K.S. (1980). "HUMAN ANTI-CHICKENPOX IMMUNOGLOBULIN IN THE PREVENTION OF CHICKENPOX". The Lancet. 315 (8164): 354–356. doi:10.1016/S0140-6736(80)90897-1. ISSN 0140-6736.
4. ↑ Arvin AM (2002). "Antiviral therapy for varicella and herpes zoster". Semin Pediatr Infect Dis. 13 (1): 12–21. PMID 12118839.
5. ↑ "A Controlled Trial of Acyclovir for Chickenpox in Normal Children — NEJM".
6. ↑ Wallace MR, Bowler WA, Murray NB, Brodine SK, Oldfield EC (1992). "Treatment of adult varicella with oral acyclovir. A randomized, placebo-controlled trial". Ann. Intern. Med. 117 (5): 358–63. PMID 1323943.
7. ↑ 7.0 7.1 Kechagia IA, Kalantzi L, Dokoumetzidis A (2015). "Extrapolation of Valacyclovir Posology to Children Based on Pharmacokinetic Modeling". Pediatr. Infect. Dis. J. 34 (12): 1342–8. doi:10.1097/INF.0000000000000910. PMID 26379165.

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