Friday, May 11, 2007

Acyclovir; to give or not to give debate

Is it advisable to prescribe acyclovir to all cases of varicella regardless of age and immune status?
Are there any clear guidelines for the treatment of varicella with acyclovir? Please share your views.


Jayakar said...

Yes I would certainly want to use acyclovir in all cases of varicella, irrespective of age and immune status.
Failure to do so hitherto has resulted in the emergence of herpes zoster and its attendant morbity particularly postherpetic neuralgia.
I shall reserve further comments after I see some more comments on this issue.

Dr Ian McColl said...

In Australia we only use it if the child is immunosupressed or has severe atopic eczema. Virtually all children are vaccinated early in life.

Ijaz said...

I have not gone through guidelines for the acyclovir in varicella. If the child is immunocompetent otherwise and no systemic involvement (pneumonitis, CNS involvement), acyclovir should not be used. Acylovir will only control viral replication, shorten the course of disease and it does not eradicate the virus from body. VZV will remain in dormant phase in the dorsal root/cranial nerve ganglia till late in life when it gets reactivated and causes herpes zoster.

Amer Ejaz said...

Acyclovir is indicated in chicken pox in adults, that too when the patients presents within 48 hours of eruption. Best results are seen within 24 hours of presentation. Later than 48 hours, resolution time is the same with or without acyclovir. What Jayakar has said about the emergence of herpes zoster is not scientifically proven, as far as I know. If you have some reference for it please share it with us. In immunocompetent children there is no need for using acyclovir. It does reduce the healing time in children also, so some advocate the use to enable the parents to return to work earlier, while others recommend to let the disease follow its course to boost immunity and reduce the chances of recurrence.

Norman Levine, MD said...

This is no compelling reason to use acyclovir in a child with uncomplicated varicella who is not immunocompromised. Firstly, the virus is only moderately susceptible and secondly, the disease is completely innocuous in the vast majority of children.