Pediatric Chickenpox Medication

  • Author: Kirsten A Bechtel, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Sep 28, 2011
 

Medication Summary

Medications used in the treatment of varicella include antivirals, antipyretics, antihistamines, and immune globulin.

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Antivirals

Class Summary

Chickenpox is usually a benign disease in children, and almost all children recover uneventfully. However, adulthood, adolescence, and pregnancy increase the risk for severe disease. Such patients are often treated with antiviral drugs. Other groups that require specific treatment are children who are immunocompromised, those who are otherwise at risk for severe disease, and those who already have severe disease. Acyclovir is the drug of choice for these situations. Other drugs are famciclovir (not approved for children) and foscarnet.

These agents are used for treatment of immunocompromised children or in healthy children who develop varicella pneumonia or encephalitis. The routine use of acyclovir in healthy children is not universally recommended. In some instances acyclovir may be considered for teenagers and adults with otherwise uncomplicated varicella.

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Acyclovir (Zovirax)

 

Acyclovir is an antiviral agent that acts by inhibiting herpes virus DNA polymerase and terminating viral replication. It reduces the number of lesions and duration of fever if it is started within 24 hours of rash appearance. In young children with uncomplicated varicella, the benefit of acyclovir therapy is only marginal, and its use is not routinely recommended. It does not affect the incidence of pruritus, complications, or secondary transmission. It is always used for complications of varicella (eg, encephalitis, pneumonia) and for immunocompromised individuals with varicella.

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Antipyretics

Class Summary

These agents inhibit central synthesis and release of prostaglandins that mediate the effect of endogenous pyrogens in the hypothalamus; thus, they promote the return of the set-point temperature to normal.

The fever is usually low grade but may be elevated. Acetaminophen is probably the safest drug to use for this purpose. Salicylate usage for varicella is associated with Reye syndrome; therefore, never prescribe these agents. Nonsteroidal anti-inflammatory drugs (NSAIDs) have been suspected of suppressing immune function and promoting infection progress in patients infected with invasive group A streptococci.

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Acetaminophen (Tylenol, Feverall, Tempra, Aspirin-Free Anacin)

 

Acetaminophen is the drug of choice because it has no association with Reye syndrome. It is available as drops containing 80 mg/0.8 mL; a suspension containing 160 mg/5 mL; a chewable tablet or capsule containing 80 mg; and a tablet containing 160 mg, 325 mg, or 500 mg.

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Ibuprofen (Motrin, Ibuprin)

 

Ibuprofen A is a propionic acid–derivative NSAID. It acts by inhibiting prostaglandin synthesis and also has anti-inflammatory and analgesic properties. It is available as an oral suspension (100 mg/5 mL) and a tab containing 200 mg, 400 mg, 600 mg, or 800 mg.

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Antihistamines

Class Summary

These agents may control pruritus by blocking the effects of endogenous release of histamine. Pruritus can be severe in varicella, preventing sleep and possibly leading to scarring or secondary infection. Nonsedating antihistaminics lack sufficient antipruritic action. The value of local preparations (eg, calamine, antihistamines) is unproved. Topical antihistamines can cause significant sedation from absorption through injured skin.

These agents act by competitive inhibition of histamine at the H1 receptor and mediate wheal and flare reactions, bronchial constriction, mucous secretion, smooth muscle contraction, edema, hypotension, central nervous system (CNS) depression, and cardiac arrhythmias.

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Diphenhydramine (Benadryl)

 

Diphenhydramine is an antihistamine that has a sedating effect and is effective for pruritus. It is available as a liquid containing 12.5 mg/5 mL, capsule containing 25 and 50 mg, and injection containing 50 mg/mL.

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Hydroxyzine (Vistaril)

 

Hydroxyzine antagonizes H1 receptors in the periphery. It may suppress histamine activity in subcortical region of the CNS. It is a second-line agent useful for pruritus when diphenhydramine is ineffective.

Hydroxyzine may only be given orally or intramuscularly (IM). It is available as a 25- or 50-mg capsule; 10 mg/5 mL suspension; 10-, 25-, or 50-mg tablet; or 25-mg/mL and 50-mg/mL for intramuscular injection.

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Immune Globulins

Class Summary

This drug provides passive immunization for susceptible individuals when administered within 96 hours of exposure.

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Varicella zoster immune globulin, human

 

Varicella zoster immune globulin (VZIG) contains immunoglobulin G (IgG) varicella-zoster antibodies. It provides passive immunization to exposed individuals at high risk of complications from varicella (eg, immunocompromised children or adults, newborns of mothers with varicella close to delivery, premature infants, normal susceptible adults, full-term infants < 1 year). Administer by deep IM injection, preferably in gluteal muscle.

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Vaccines

Class Summary

Varicella vaccine consists of live-attenuated Oka strain varicella virus. The vaccine is safe and highly immunogenic. It was approved for use in the United States in 1995 and has greatly reduced the incidence of and mortality from varicella.[6] The vaccine has a protective efficacy of 71-100% against varicella. However, it affords a much greater degree of protection against moderate and severe varicella (95-100%).[25]

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Varicella virus vaccine (Varivax)

 

The varicella virus vaccine is indicated for children aged between 12 months and 12 years.

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Contributor Information and Disclosures
Author

Kirsten A Bechtel, MD  Associate Professor, Department of Pediatrics, Yale University School of Medicine; Attending Physician, Department of Pediatric Emergency Medicine, Yale-New Haven Children's Hospital

Kirsten A Bechtel, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Archana Chatterjee, MD, PhD  Professor of Pediatrics, Medical Microbiology and Immunology, and Pharmacy, Division of Pediatric Infectious Diseases, Chief of Division of Pediatric Infectious Diseases, Creighton University School of Medicine; Hospital Epidemiologist and Medical Director of Infection Control, Children's Hospital

Archana Chatterjee, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, International Society for Infectious Diseases, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Richard Lichenstein, MD  Associate Professor, Pediatric Emergency Department, University of Maryland School of Medicine

Richard Lichenstein, MD is a member of the following medical societies: American Academy of Pediatrics and American Medical Association

Disclosure: Nothing to disclose.

Parang N Mehta, MD  Consulting Staff, Department of Pediatrics, Mehta Hospital, Surat, India

Parang N Mehta, MD is a member of the following medical societies: Indian Academy of Pediatrics and Indian Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Leonard R Krilov, MD  Chief of Pediatric Infectious Diseases and International Adoption, Vice Chair, Department of Pediatrics, Professor of Pediatrics, Winthrop University Hospital

Leonard R Krilov, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Medimmune Grant/research funds Cliinical trials; Medimmune Honoraria Speaking and teaching; Medimmune Consulting fee Consulting

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Leslie L Barton, MD  Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH  Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

References

  1. Hall S, Maupin T, Seward J, Jumaan AO, Peterson C, Goldman G, et al. Second varicella infections: are they more common than previously thought?. Pediatrics. Jun 2002;109(6):1068-73. [Medline].

  2. Rockley PF, Tyring SK. Pathophysiology and clinical manifestations of varicella zoster virus infections. Int J Dermatol. Apr 1994;33(4):227-32. [Medline].

  3. Dowell SF, Bresee JS. Severe varicella associated with steroid use. Pediatrics. Aug 1993;92(2):223-8. [Medline].

  4. Davis MM, Patel MS, Gebremariam A. Decline in varicella-related hospitalizations and expenditures for children and adults after introduction of varicella vaccine in the United States. Pediatrics. Sep 2004;114(3):786-92. [Medline].

  5. [Guideline] American Academy of Pediatrics Committee on Infectious Diseases. Prevention of varicella: recommendations for use of varicella vaccines in children, including a recommendation for a routine 2-dose varicella immunization schedule. Pediatrics. 2007;120:221-231. [Medline]. [Full Text].

  6. Zhou F, Harpaz R, Jumaan AO, et al. Impact of varicella vaccination on health care utilization. JAMA. Aug 17 2005;294(7):797-802. [Medline]. [Full Text].

  7. Nguyen HQ, Jumaan AO, Seward JF. Decline in mortality due to varicella after implementation of varicella vaccination in the United States. N Engl J Med. Feb 3 2005;352(5):450-8. [Medline].

  8. Seward JF, Watson BM, Peterson CL, Mascola L, Pelosi JW, Zhang JX, et al. Varicella disease after introduction of varicella vaccine in the United States, 1995-2000. JAMA. Feb 6 2002;287(5):606-11. [Medline].

  9. Shah SS, Wood SM, Luan X, Ratner AJ. Decline in varicella-related ambulatory visits and hospitalizations in the United States since routine immunization against varicella. Pediatr Infect Dis J. Mar 2010;29(3):199-204. [Medline]. [Full Text].

  10. National, state, and local area vaccination coverage among children aged 19-35 months--United States, 2006. MMWR Morb Mortal Wkly Rep. Aug 31 2007;56(34):880-5. [Medline].

  11. Buchholz U, Moolenaar R, Peterson C, Mascola L. Varicella outbreaks after vaccine licensure: should they make you chicken?. Pediatrics. Sep 1999;104(3 Pt 1):561-3. [Medline]. [Full Text].

  12. Galil K, Lee B, Strine T, et al. Outbreak of varicella at a day-care center despite vaccination. N Engl J Med. Dec 12 2002;347(24):1909-15. [Medline]. [Full Text].

  13. Seward JF, Zhang JX, Maupin TJ, Mascola L, Jumaan AO. Contagiousness of varicella in vaccinated cases: a household contact study. JAMA. Aug 11 2004;292(6):704-8. [Medline].

  14. Ozaki T, Nagai H, Kimura T, Ichikawa T, Suzuki S, Kito H, et al. The age distribution of neutralizing antibodies against varicella-zoster virus in healthy individuals. Biken J. Mar 1980;23(1):9-14. [Medline].

  15. Kouwabunpat D, Hoffman J, Adler R. Varicella complicated by group A streptococcal sepsis and osteonecrosis. Pediatrics. Oct 1999;104(4 Pt 1):967-9. [Medline]. [Full Text].

  16. Perella D, Fiks AG, Jumaan A, Robinson D, Gargiullo P, Pletcher J, et al. Validity of reported varicella history as a marker for varicella zoster virus immunity among unvaccinated children, adolescents, and young adults in the post-vaccine licensure era. Pediatrics. May 2009;123(5):e820-8. [Medline].

  17. Cowan MR, Primm PA, Scott SM, Abramo TJ, Wiebe RA. Serious group A beta-hemolytic streptococcal infections complicating varicella. Ann Emerg Med. Apr 1994;23(4):818-22. [Medline].

  18. Doctor A, Harper MB, Fleisher GR. Group A beta-hemolytic streptococcal bacteremia: historical overview, changing incidence, and recent association with varicella. Pediatrics. Sep 1995;96(3 Pt 1):428-33. [Medline].

  19. Lesko SM, O'Brien KL, Schwartz B, Vezina R, Mitchell AA. Invasive group A streptococcal infection and nonsteroidal antiinflammatory drug use among children with primary varicella. Pediatrics. May 2001;107(5):1108-15. [Medline].

  20. Tappeiner C, Aebi C, Garweg JG. Retinitis and optic neuritis in a child with chickenpox: case report and review of literature. Pediatr Infect Dis J. Dec 2010;29(12):1150-2. [Medline].

  21. Matsukura H, Murakami M, Sakaki H, Mitani T, Shimura S. Varicella glomerulonephritis preceding the cutaneous lesions. Clin Nephrol. Aug 2009;72(2):161-2. [Medline].

  22. Pastuszak AL, Levy M, Schick B, et al. Outcome after maternal varicella infection in the first 20 weeks of pregnancy. N Engl J Med. Mar 31 1994;330(13):901-5. [Medline]. [Full Text].

  23. Derrick CW Jr, Lord L. In utero varicella-zoster infections. South Med J. Nov 1998;91(11):1064-6. [Medline].

  24. American Academy of Pediatrics Committee on Infectious Diseases: The use of oral acyclovir in otherwise healthy children with varicella. Pediatrics. Mar 1993;91(3):674-6. [Medline].

  25. [Guideline] Marin M, Meissner HC, Seward JF. Varicella prevention in the United States: a review of successes and challenges. Pediatrics. Sep 2008;122(3):e744-51. [Medline]. [Full Text].

  26. Pinquier D, Gagneur A, Balu L, et al. Prevalence of anti-varicella-zoster virus antibodies in French infants under 15 months of age. Clin Vaccine Immunol. Apr 2009;16(4):484-7. [Medline].

  27. [Guideline] Update: recommendations from the Advisory Committee on Immunization Practices (ACIP) regarding administration of combination MMRV vaccine. MMWR Morb Mortal Wkly Rep. Mar 14 2008;57(10):258-60. [Medline].

  28. [Guideline] Marin M, Güris D, Chaves SS, Schmid S, Seward JF. Prevention of varicella: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. Jun 22 2007;56:1-40. [Medline].

  29. Lee LE, Ho H, Lorber E, et al. Vaccine-era varicella epidemiology and vaccine effectiveness in a public elementary school population, 2002-2007. Pediatrics. Jun 2008;121(6):e1548-54. [Medline]. [Full Text].

  30. Verstraeten T, Jumaan AO, Mullooly JP, et al. A retrospective cohort study of the association of varicella vaccine failure with asthma, steroid use, age at vaccination, and measles-mumps-rubella vaccination. Pediatrics. Aug 2003;112(2):e98-103. [Medline]. [Full Text].

  31. Chaves SS, Gargiullo P, Zhang JX, et al. Loss of vaccine-induced immunity to varicella over time. N Engl J Med. Mar 15 2007;356(11):1121-9. [Medline].

  32. Arbeter AM, Granowetter L, Starr SE, et al. Immunization of children with acute lymphoblastic leukemia with live attenuated varicella vaccine without complete suspension of chemotherapy. Pediatrics. Mar 1990;85(3):338-44. [Medline].

  33. Quian R J, Protasio P A, Dall'orso V P, et al. [Varicella outbreak in a village in Uruguay]. Rev Chilena Infectol. Feb 2010;27(1):47-51. [Medline]. [Full Text].

  34. Watson B, Seward J, Yang A, Witte P, Lutz J, Chan C. Postexposure effectiveness of varicella vaccine. Pediatrics. Jan 2000;105(1 Pt 1):84-8. [Medline].

  35. Klein NP, Fireman B, Yih WK, et al. Measles-mumps-rubella-varicella combination vaccine and the risk of febrile seizures. Pediatrics. Jul 2010;126(1):e1-8. [Medline].

  36. Hviid A. Measles-mumps-rubella-varicella combination vaccine increases risk of febrile seizure. J Pediatr. Jan 2011;158(1):170. [Medline].

  37. [Guideline] Marin M, Broder KR, Temte JL, Snider DE, Seward JF. Use of combination measles, mumps, rubella, and varicella vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. May 7 2010;59:1-12. [Medline].

  38. American Academy of Pediatrics Committee on Infectious Diseases. Policy Statement--Prevention of Varicella: Update of Recommendations for Use of Quadrivalent and Monovalent Varicella Vaccines in Children. Pediatrics. Aug 28 2011;[Medline].

 
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The pleomorphic rash characteristic of varicella. Papules, vesicles, and pustules are concurrently present.
Papulovesicular lesions on arm in varying stages of healing in this infant with varicella. Photograph courtesy of Susan Feigelman, MD.
 
 
 
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