eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease
Varicella: Treatment & Medication
Updated: Jul 31, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- Manage pruritus in patients with varicella with cool compresses and regular bathing.
- Discourage scratching to avoid scarring. Trimming the child's fingernails and having the child wear mittens while sleeping may reduce scratching.
Consultations
- Consult with an infectious disease specialist in the following situations:
- Progressive or severe varicella
- Life-threatening complications (eg, encephalitis, pneumonia)
- Serious secondary bacterial infections, especially group A streptococcal superinfections, which may evolve rapidly into necrotizing fasciitis and toxic shock syndrome
- Children who develop severe and life-threatening varicella complications may require hospitalization in an ICU.
Diet
- Advise parents to provide a full and unrestricted diet to the child.
- Some children with varicella have reduced appetite and should be encouraged to take sufficient fluids to maintain hydration. Adequate hydration is especially important if the child is receiving acyclovir because the drug can crystallize in the renal tubules if administered to dehydrated individuals.
Activity
- No activity restrictions are needed for young children with uncomplicated varicella.
Medication
Antivirals
Chickenpox is not always benign. In certain well-defined groups, varicella can be severe and even fatal. Antiviral drugs are recommended for adolescents, adults, and children on steroid or salicylate therapy and for children who are otherwise immunocompromised. Acyclovir is the only adequately studied drug of this class.
Acyclovir (Zovirax)
Antiviral that acts by inhibiting herpes virus DNA polymerase and terminating viral replication. It reduces the number of lesions and duration of fever if started within 24 h of appearance of rash. In young children with uncomplicated varicella, benefit is only marginal and use is not routinely recommended. It does not affect incidence of pruritus, complications, or secondary transmission. It is always used for complications of varicella (eg, encephalitis, pneumonia) and for immunocompromised individuals with varicella. Available as cap (200-800 mg), PO liquid (400 mg/5 mL), and parenteral injection (500 mg/mL).
Adult
800 mg PO 5 times/d for 7 d
1500 mg/m2/d IV divided q8h for 7-10 d for encephalitis, pneumonia, or infection in immunocompromised patients
Pediatric
80 mg/kg/d PO divided in 4-5 doses for 5 d; not to exceed 3200 mg/d
Encephalitis or pneumonia: Administer as in adults
Concomitant use of probenecid or zidovudine prolongs half-life and increases CNS toxicity of acyclovir
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in renal failure or when using nephrotoxic drugs; may cause malaise, GI upset, and rash; PO bioavailability is poor, making IV administration essential for patients with severe varicella and for immunocompromised patients
Antipyretics
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.
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.
Acetaminophen (Tylenol, Feverall, Tempra, Aspirin-Free Anacin)
DOC because has no association with Reye syndrome; available as gtt containing 80 mg/0.8 mL, susp containing 160 mg/5 mL, chewable tab or cap containing 80 mg, and tab containing 160 mg, 325 mg, and 500 mg.
Adult
500-650 mg/dose PO q4-6h prn for fever; not to exceed 4 g/d
Pediatric
10-15 mg/kg PO q4-6h prn for fever; not to exceed 60 mg/kg/d
Rifampin can reduce analgesic effects of acetaminophen; coadministration with barbiturates, carbamazepine, hydantoins, and isoniazid may increase hepatotoxicity
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Hepatotoxicity possible in persons with chronic alcoholism following various dose levels; severe or recurrent pain or high or continued fever may indicate a serious illness; contained in many OTC products and combined use with these products may result in cumulative acetaminophen doses exceeding recommended maximum dose
Ibuprofen (Motrin, Ibuprin)
A propionic acid–derivative NSAID; acts by inhibiting prostaglandin synthesis; also has anti-inflammatory and analgesic properties; available as an PO suspension (100 mg/5 mL) and tab containing 300 mg, 400 mg, 600 mg, or 800 mg.
Adult
200-400 mg PO q4-6h prn for fever
Pediatric
6 months to 12 years: 4-10 mg/kg/dose PO tid/qid; not to exceed 40 mg/kg/d
>12 years: Administer as in adults
Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; closely monitor PT (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Documented hypersensitivity; peptic ulcer disease, recent GI bleeding or perforation; renal insufficiency; high risk of bleeding
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Category D in third trimester of pregnancy; caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in anticoagulation abnormalities or during anticoagulant therapy; causes nausea, stomach upset, and rashes in 3-9% of patients; causes maculopapular rash and pruritus in 1-3% of recipients; may confuse clinical picture of varicella
Antihistamines
These agents may control pruritus by blocking 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.
Diphenhydramine (Benadryl)
Antihistamine has a sedating effect and is effective for pruritus; available as a liquid containing 12.5 mg/5 mL, cap containing 25 and 50 mg, and injections containing 10 and 50 mg/mL.
Adult
25-50 mg PO tid/qid
Pediatric
5 mg/kg/d PO divided tid/qid; not to exceed 300 mg/d
Potentiates effect of CNS depressants; because of alcohol content, do not administer syrup form to patient taking medications that can cause disulfiramlike reactions
Documented hypersensitivity; MAOIs
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
May exacerbate angle-closure glaucoma, hyperthyroidism, peptic ulcer, and urinary tract obstruction
More on Varicella |
| Overview: Varicella |
| Differential Diagnoses & Workup: Varicella |
 Treatment & Medication: Varicella |
| Follow-up: Varicella |
| Multimedia: Varicella |
| References |
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References
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Further Reading
Keywords
varicella, chickenpox, chicken pox, waterpox, water pox, varicellovirus, varicella-zoster virus, varicella pneumonia, varicella encephalitis, group A streptococcal disease, Reye syndrome, congenital varicella syndrome, growth retardation, microcephaly, cortical atrophy, limb hypoplasia, microphthalmia, cataracts, chorioretinitis, infantile zoster, neonatal varicella, maternal varicella, diagnosis, treatment
