Management of varicella zoster (chicken pox) and herpes zoster (shingles)

First Line

Second Line

Specialist

Hospital Only

Invasive Group A Streptococcal infections have increased in incidence and need to be assessed rapidly in hospital. Maintain a high index of suspicion in patients with a high fever, severe muscle aches, confusion, unexplained D&V, local muscle tenderness, or severe pain out of proportion to external signs, hypotension, a flat red rash over large area of the body, conjunctival suffusion.

Varicella zoster/chicken pox and herpes zoster/shingles

Pregnant/ immunocompromised/ neonate exposed to chicken pox or shingles: seek urgent specialist advice.

Chicken pox, consider aciclovir:

If onset of rash less than 24 hours & over 14 years of age or
Severe pain or
Dense/oral rash or
Secondary household case or
Taking steroids or
A smoker

Shingles, treat if over 50 years of age and:

Within 72 hours of rash (post herpatic neuralgia is rare if under 50 years of age) or
Active ophthalmic or
Ramsey Hunt syndrome or
Eczema

If indicated:

Aciclovir tablets

800mg 5 times a day for 7 days

2nd line for shingles only if compliance a problem (less cost effective)

Valaciclovir tablets

1000mg every 8 hours for 7 days.
Children: See BNFC for dose

Formulary