Therapy | Varicella zoster virus (VZV)

Therapy

The herpes zoster can be treated with the virustatics. Virustatics are substances that can inhibit the reproduction of viruses. They are comparable to antibiotics that prevent bacteria from multiplying.

Among other things they are used: According to the current status, Brivudin has proven to be the most effective drug. Therapy should be started as early as possible (within the first 72 hours) to avoid complications. In particular, nerve pain, which is more frequent with increasing age, should be mentioned here.

This can manifest itself in the affected skin area after having undergone shingles (post-herpetic zoster neuralgia). Pain therapy initiated in time also helps to prevent this post-zosteric neuralgia. The administration of corticoids (30 – 60 mg prednisone equivalent) has long been controversial because it additionally weakens the body’s own immune defenses, but it is also said to have a preventive effect against post-zosteric neuralgia by suppressing the development of vascular inflammation.

In the case of zoster ophthalmicus, it is advisable to administer acyclovir eye ointment to prevent permanent damage to the cornea (scar tissue). If the blisters on the skin become additionally infected with bacteria (superinfection), they should be treated with ointments containing antibiotics.

  • Aciclovir (intravenous or tablets, 5x/day 800 mg)
  • Valaciclovir (tablets 3x/day 1 g over 7 days),
  • Famciclovir (tablets, 3x/day 250 mg) or
  • Brivudine (Zostex® tablets 1x/day 125 mg)

Complication

Complications of a zoster infection:

  • Postherpetic zoster neuralgia (postzosteric neuralgia). This is the most severe burning, continuous pain (neuralgic pain) in the affected segment, although the infection has long been defeated. This is permanent damage to the nerve caused by the expired infection. Neuralgic pain is extremely difficult to control, as conventional painkillers are ineffective. Treatment is a combination of painkillers, a tricyclic antidepressant and the antiepileptic drug carbamazepine
  • Polyneuropathies
  • Guillain-Barré Syndrome

All articles in this series:

  1. Varicella zoster virus (VZV)
  2. Varicella zoster virus and shingles – what is the connection?
  3. Therapy