Chickenpox medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{CMG}} | {{CMG}}; {{AE}} {{ARK}} | ||
{{Chickenpox}} | {{Chickenpox}} | ||
==Overview== | ==Overview== | ||
There is no definitive treatment for | There is no definitive treatment for [[chickenpox]], only supportive treatment exists, to minimize discomfort and [[pruritus]]. [[Antiviral|Antiviral therapy]] with [[acyclovir]] and [[valacyclovir]] is beneficial if given within the first 24 hours of appearance of the [[rash]]. | ||
==Medical Therapy== | ==Medical Therapy== | ||
===Symptomatic treatment=== | ===Symptomatic treatment=== | ||
*Mild [[sodium bicarbonate]] baths, [[antihistamine]] medication to help ease itching | *Mild [[sodium bicarbonate]] baths, [[antihistamine]] medication to help ease [[itching]] | ||
*[[Acetaminophen]] to reduce fever | *[[Acetaminophen]] to reduce [[fever]] | ||
*[[Ibuprofen]] | *[[Ibuprofen]] | ||
* | *Aspirin must not be given to children with [[chickenpox]] to avoid potentially [[fatal]] [[Reye's Syndrome]]<ref>{{cite web | author=US Centers for Disease Control and Prevention | url=http://www.cdc.gov/vaccines/vpd-vac/varicella/dis-faqs-gen-treatment.htm | title=Varicella Treatment Questions & Answers | work=CDC Guidelines | publisher=CDC | accessdate=2007-8-23}}</ref><ref>{{cite journal |author=Somekh E, Dalal I, Shohat T, Ginsberg''''' GM''''', Romano O |title=The burden of uncomplicated cases of chickenpox in Israel |journal=J. Infect. |volume=45 |issue=1 |pages=54-7 |year=2002 |pmid=12217733 |doi=}}</ref> | ||
* Maintaining adequate hydration | * Maintaining adequate [[hydration]] | ||
* Intravenous [[immunoglobulin]] therapy is also considered in pregnant women, [[immunocompromised]] patients and newborns who are not vaccinated. | * Intravenous [[immunoglobulin]] therapy is also considered in [[pregnant]] women, [[immunocompromised]] patients and [[newborns]] who are not [[vaccinated]]<ref name="EvansPollock1980">{{cite journal|last1=Evans|first1=E.B.|last2=Pollock|first2=T.M.|last3=Cradock-Watson|first3=J.E.|last4=Ridehalgh|first4=M.K.S.|title=HUMAN ANTI-CHICKENPOX IMMUNOGLOBULIN IN THE PREVENTION OF CHICKENPOX|journal=The Lancet|volume=315|issue=8164|year=1980|pages=354–356|issn=01406736|doi=10.1016/S0140-6736(80)90897-1}}</ref> | ||
=== | === Antiviral Therapy === | ||
* | *'''Indications for antiviral therapy:''' <ref name="pmid12118839">{{cite journal| author=Arvin AM| title=Antiviral therapy for varicella and herpes zoster. | journal=Semin Pediatr Infect Dis | year= 2002 | volume= 13 | issue= 1 | pages= 12-21 | pmid=12118839 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12118839 }} </ref> | ||
*[[ | :*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]] [[Disseminated disease|dissemination]] and [[visceral]] involvement and should always receive [[antiviral]] 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]]. | * [[Antiviral Therapy|Antiviral therapy]] with [[acyclovir]] and [[valacyclovir]] is beneficial if given within the first 24 hrs of appearance of the rash.<ref name="urlA Controlled Trial of Acyclovir for Chickenpox in Normal Children — NEJM">{{cite web |url=http://www.nejm.org/doi/full/10.1056/NEJM199111283252203#t=article |title=A Controlled Trial of Acyclovir for Chickenpox in Normal Children — NEJM |format= |work= |accessdate=}}</ref><ref name="pmid1323943">{{cite journal |vauthors=Wallace MR, Bowler WA, Murray NB, Brodine SK, Oldfield EC |title=Treatment of adult varicella with oral acyclovir. A randomized, placebo-controlled trial |journal=Ann. Intern. Med. |volume=117 |issue=5 |pages=358–63 |year=1992 |pmid=1323943 |doi= |url=}}</ref><ref name="pmid26379165">{{cite journal |vauthors=Kechagia IA, Kalantzi L, Dokoumetzidis A |title=Extrapolation of Valacyclovir Posology to Children Based on Pharmacokinetic Modeling |journal=Pediatr. Infect. Dis. J. |volume=34 |issue=12 |pages=1342–8 |year=2015 |pmid=26379165 |doi=10.1097/INF.0000000000000910 |url=}}</ref> | ||
*[[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)<ref name="pmid26379165">{{cite journal |vauthors=Kechagia IA, Kalantzi L, Dokoumetzidis A |title=Extrapolation of Valacyclovir Posology to Children Based on Pharmacokinetic Modeling |journal=Pediatr. Infect. Dis. J. |volume=34 |issue=12 |pages=1342–8 |year=2015 |pmid=26379165 |doi=10.1097/INF.0000000000000910 |url=}}</ref> | **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)<ref name="pmid26379165">{{cite journal |vauthors=Kechagia IA, Kalantzi L, Dokoumetzidis A |title=Extrapolation of Valacyclovir Posology to Children Based on Pharmacokinetic Modeling |journal=Pediatr. Infect. Dis. J. |volume=34 |issue=12 |pages=1342–8 |year=2015 |pmid=26379165 |doi=10.1097/INF.0000000000000910 |url=}}</ref> | ||
**Alternate regimen: [[Valacyclovir]] 20 mg per kg q8h for 5 days (dose not to exceed 1000 mg per day) | **Alternate regimen: [[Valacyclovir]] 20 mg per kg q8h for 5 days (dose not to exceed 1000 mg per day) | ||
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Latest revision as of 20:53, 29 July 2020
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
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
Symptomatic treatment
- 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
- 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
References
- ↑ US Centers for Disease Control and Prevention. "Varicella Treatment Questions & Answers". CDC Guidelines. CDC. Retrieved 2007-8-23. Check date values in:
|accessdate=(help) - ↑ 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.
- ↑ 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.
- ↑ Arvin AM (2002). "Antiviral therapy for varicella and herpes zoster". Semin Pediatr Infect Dis. 13 (1): 12–21. PMID 12118839.
- ↑ "A Controlled Trial of Acyclovir for Chickenpox in Normal Children — NEJM".
- ↑ 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.
- ↑ 7.0 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.