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Shingles - Management
Basis for recommendation

  • Immunocompetent adults
    • Evidence from clinical trials suggests that famciclovir and valaciclovir have similar or superior efficacy and safety/tolerability compared with aciclovir for the treatment of herpes zoster [Tyring, 2007]. In view of this, CKS suggests that the decision on which antiviral to use should be made by the clinician, taking into account cost and compliance issues for each individual.
  • Immunocompromised adults
    • There is only very limited evidence from clinical trials on the efficacy of oral antiviral regimens in immunocompromised adults.
    • The recommendation that standard doses of oral antivirals should be used (in individuals who do not need referral) until all lesions have healed is based on expert consensus [Dworkin et al, 2007], and expert opinion from a narrative review [Ahmed et al, 2007].
  • Pregnant women
    • CKS has recommended seeking specialist advice for pregnant women with shingles because the safety of antiviral treatment in pregnancy has not been firmly established. Pregnant women should only be treated if the potential benefits of treatment outweigh the risk to the fetus. Most pregnant women are thought to be at lower risk of post-herpetic neuralgia because of their relatively younger age [Dworkin et al, 2007].
  • Topical antivirals
    • CKS has not recommended the use of topical antiviral treatment because a systematic review (search date: December 2006) found insufficient evidence to determine whether its use during an acute episode of shingles reduces the risk of post-herpetic neuralgia [Wareham, 2006].

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