Treatment and Management of Shingles

By Zhi Mei

Treatment and management of Shingles

· Cessation of viral replication

· Reduction in pain

· Prevent complications

Antiviral therapy

· Systemic antiviral therapy is strongly recommended in patients

o More than 50 years old

o Moderate to severe pain

o Moderate to severe rash

· Those with rash more than 72 hours, must seek further evaluation

Generic Name	Brand Name	Most Common Adverse Effects
Acyclovir	Zovirax	nausea, headache
Famicyclovir	Famvir	nausea, headache
Valacyclovir	Valtrex	nausea, headache

Analgesic therapy

· Pain should be assessed and treated properly

· Initiate with smaller doses in elderly people

· Eg. NSAIDs, opioids, tramadols

Oral corticosteroids

· May reduce need for analgesics

· Strong anti-inflammatory medicine

· Contraindication include hypertension and diabetes

Anticonvulsants

· These agents are used to manage severe muscle spasms and provide sedation in neuralgia

· To treat postherpetic neuralgia

Other medications:

• Zostrix to prevent postherpetic neuralgia (nerve damage by herpes zoster in the same dermatomic area)

Herpes Zoster Vaccine (live attenuated, varicella zoster vaccine)

· Store frozen until needed

· Subcutaneous administration at deltoid region

· Use sterile syringe

· Use immediately after 30 minutes

isolated while lesions are oozing to prevent infection of others -- especially pregnant women.

Topical antibiotics cream, applied directly to the skin, to stop infection of the blisters

http://www.nlm.nih.gov/medlineplus/ency/article/000858.htm

http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=10222&nbr=5385

http://www.nadona.org/agenda09/Mann_HZoster.pdf

http://www.jaoa.org/cgi/content/full/107/suppl_1/S8