Management of Shingles

• The main challenge in the management of shingles is the rapid treatment of the pain involved.
• Early and adequate antiviral treatment will help to reduce the severity and duration of the pain involved.
• The use of antiviral agents is to stop virus replication as quickly as possible and minimize nerve damage
o There are three antiviral compounds which have been assessed for their ability to speed the resolution of shingles
 Aciclovir
• Total Pain duration is greatly reduced
• 800 mg 5 times per day for 7 days
 Famciclovir
• 500 mg 3 times per day for 7 days
 Valaciclovir
• Speeds pain resolution significantly faster than acyclovir
• 1 g 3 times per day for 7 days
o Must be administered within 72 hours of rash onset
• These antiviral agents are appropriate for all patients presenting with shingles within 72 hours of rash onset
• Valaciclovir is probably the most effective agent available as it is the fastest at resolving the pain associated with shingles.
• Famciclovir and valaciclovir offer more convenient dosing than acyclovir.
• Complications can be reduced to 20% or less by early treatment, as well as reducing duration of lesion formation and time to healing