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 five times daily for 7 days
Child doses see BNFC

Formulary