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Shingles - Management
When should I prescribe an antiviral drug?
- Start an oral antiviral drug within 72 hours of rash onset for:
- Anyone over the age of 50 years with shingles.
- People of any age with any of the following criteria:
- Ophthalmic involvement (seek immediate specialist advice, or refer immediately).
- Immunocompromised (consider treating in primary care if the rash is localized and they are not systemically unwell; seek immediate specialist advice or refer immediately if the rash is severe, widespread, or multiple dermatomes are involved, they are systemically unwell, or there is severe immunocompromise).
- Non-truncal involvement (e.g. shingles affecting the neck, limbs, or perineum).
- Moderate or severe pain.
- Moderate or severe rash.
- If it is not possible to initiate treatment within 72 hours, consider starting an antiviral drug up to 1 week after rash onset, especially if the person is at higher risk of severe shingles or complications (e.g. continued vesicle formation, older age, immunocompromised, or severe pain).
- For pregnant women, seek specialist advice regarding prescribing antiviral treatment in pregnancy.
- For immunocompetent children with shingles, antiviral treatment is not recommended.
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