Varicella Health Article

Treatment

In almost all cases, varicella is a self-limited disease, and symptomatic treatment (with acetaminophen to control fever, lotions for pruritus, and fluid substitution to maintain hydration) is sufficient. Treatment with acetyl salicylic acid is strongly discouraged in children because of its association with Reye's syndrome. ¹²⁴ Moreover, the use of non-steroidal anti-inflammatory drugs in children with varicella might increase the risk of necrotising soft tissue infections and invasive group A β-haemolytic streptococci infections: several prospective multicentre case-control studies produced conflicting results, so that this association cannot be ruled out with certainty. ^125,126 Secondary bacterial infections require rapid administration of antibiotics. Treatment with antivirals is mandatory for patients at risk for severe disease (such as immunocompromised hosts and newborns whose mothers acquired infection around the time of delivery) and for any people with varicella-zoster virus infection with virally mediated complications (such as ocular involvement, pneumonia, or encephalitis). Acyclovir is most effective if given intravenously within 72 h of onset of disease. ¹²⁷ The recommended daily dosage for children is 1500 mg/m ² per day; for adolescents and adults it is 30 mg/kg per day in three divided doses. Since the drug is excreted via the kidneys, enough fluids need to be given at the same time as the drug to avoid renal damage, and dosage should be reduced appropriately in patients with renal dysfunction.

In healthy children with varicella, treatment with oral acyclovir within 24 h of onset of illness resulted in a 1-day reduction of fever and a 15–30% reduction in the severity of cutaneous and systemic signs and symptoms. ¹²⁸ Acyclovir treatment did not seem to reduce the rate of complications; however, the number of complications was small and most were bacterially mediated. ¹²⁸ The recommended dosage is 80 mg/kg per day divided into four doses for children and 4 g per day divided into five doses for adults for 5 days. Some authorities do not recommend routine use of oral antivirals in uncomplicated cases of varicella in healthy children, but endorse their use (if initiated within 24 h of rash onset) for groups of people at higher risk of severe diseases, including otherwise-healthy non-pregnant individuals 13 years of age or older, children older than 12 months with a chronic cutaneous or pulmonary disorder, and those receiving long-term salicylate therapy. ¹²⁹ Famciclovir and valacyclovir are currently licensed for treatment of herpes zoster but not for varicella. Varicella-zoster virus resistance to acyclovir is not a common problem and has so far been reported mainly in patients with underlying HIV infection. Resistance should be suspected in patients failing to respond to treatment, and intravenous foscarnet (up to 200 mg/kg per day in two or three divided doses) could be used if appropriate. ¹³⁰