10. INFECTIONS Indication Comment Drug Dose Duration Herpes zoster if: (shingles) >50 years (as they are at highest risk for post-herpetic neuralgia) and within 72 First Choice hours of onset of rash Aciclovir 800mg 5 x daily 7 days Ophthalmic zoster (at any age) refer immediately – Immunocompromised (at any age) seek Virology advice – Pregnancy seek Virology advice If non-compliant with first – Non-truncal involvement (at any age) choice Eczema (at any age) Valaciclovir 1g tds 7 days Ramsey Hunt Syndrome (at any age) or Presents with moderate or severe pain or moderate or severe rash (at any age) Famciclovir 500mg tds 7 days or Nb. if non-compliant with first 750mg bd choice assess likelihood of (more expensive) compliance with others as these are significantly more expensive. Varicella Consider treatment for adults & adolescents seen within 24 hours of onset Aciclovir 800mg 5 x daily 7 days zoster of rash. (chickenpox) Seek advice from Virologist if patient is pregnant or a neonate or immunocompromised. Herpes Treatment should begin as early as possible after the start of an infection. Minor oral infection simplex - Oral Topical treatment only effective if initiated prior to vesicles appearing Aciclovir cream 5% 5 x daily 5 days Obtain advice from Virologist if patient is immunocompromised. Consider GUM referral Consider dermatology referral if patient has eczema herpeticum Extensive oral infection Consider seeking special specialist advice if patient is pregnant (particularly near (severe herpetic term) stomatitis) Seek specialist advice if neonatal herpes simplex is suspected Aciclovir 200mg 5 x daily 5 days Immunocompromised Seek advice from Virologist Indication Comment Drug Dose Duration Herpes Ideally should be referred to GUM Immunocompetent - if simplex cannot be referred to GUM – Genital The following categories of patient must be referred to the appropriate speciality
10. INFECTIONS Indication Comment Drug Dose Duration Herpes zoster (shingles) if: >50 years (as they are at highest risk for post-herpetic neuralgia) and within 72 hours of onset of rash Ophthalmic zoster (at any age) – refer immediately Immunocompromised (at any age) – seek Virology advice Pregnancy – seek Virology advice Non-truncal involvement (at any age) Eczema (at any age) Ramsey Hunt Syndrome (at any age) Presents with moderate or severe pain or moderate or severe rash (at any age) First Choice Aciclovir If non-compliant with first choice Valaciclovir or Famciclovir Nb. if non-compliant with first choice assess likelihood of compliance with others as these are significantly more expensive. 800mg 5 x daily 1g tds 500mg tds or 750mg bd (more expensive) 7 days 7 days 7 days Varicella zoster (chickenpox) Consider treatment for adults & adolescents seen within 24 hours of onset of rash. Seek advice from Virologist if patient is pregnant or a neonate or immunocompromised. Aciclovir 800mg 5 x daily 7 days Herpes simplex - Oral Treatment should begin as early as possible after the start of an infection. Topical treatment only effective if initiated prior to vesicles appearing Obtain advice from Virologist if patient is immunocompromised. Consider GUM referral Consider dermatology referral if patient has eczema herpeticum Consider seeking special specialist advice if patient is pregnant (particularly near term) Seek specialist advice if neonatal herpes simplex is suspected Minor oral infection Aciclovir cream 5% Extensive oral infection (severe herpetic stomatitis) Aciclovir Immunocompromised Seek advice from Virologist 5 x daily 200mg 5 x daily 5 days 5 days Indication Comment Drug Dose Duration Herpes simplex – Genital Ideally should be referred to GUM The following categories of patient must be referred to the appropriate speciality Immunocompetent - if cannot be referred to GUM