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. Author manuscript; available in PMC: 2010 Dec 1.
Published in final edited form as: Am J Transplant. 2009 Dec;9(Suppl 4):S108–S115. doi: 10.1111/j.1600-6143.2009.02901.x

Table 1.

Recommendations for VZV Treatment in Solid Organ Transplant Recipients

Disease Treatment Evidence Comments
Outpatient Treatment
Herpes Zoster

  • Valacyclovir and Famcicovir is not FDA approved for treatment of herpes zoster, but is commonly used in clinical practice

  • Valacyclovir is only recommended for children ≥2 to 18 years of age

  • Antivirals are typically given for at least 7 days or until lesions have crusted over, which may be delayed in immunocompromised hosts

  • IV acyclovir is recommended in children <2 yrs of age [10 mg/kg IV every 8 hours] or those who cannot tolerate oral therapy
 Localized (Dermatomal) Acyclovir
800 mg PO five times daily (adults and children ≥ 12 yrs)
20 mg/kg PO four times daily (pediatrics > 2 years; max of
800 mg/dose)

OR

Valacyclovir
1 gram PO three times daily (adults)
20 mg/kg PO three times daily (pediatric >2 and ≤18)
years)†

OR

Famciclovir
500 mg PO three times daily (adults only) 		Evidence II-1
Inpatient Treatment
Acute Varicella Acyclovir
10 mg/kg IV every 8 hours		 Evidence II-2

  • IV therapy can be changed to oral therapy once the patient has significantly improved

  • Careful monitoring of renal function is needed while on IV therapy, and dosing should be adjusted for renal insufficiency
Herpes Zoster Disseminated or Invasive Disease or Herpes zoster ophthalmicus or Ramsay-Hunt syndrome/Herpes zoster oticus Acyclovir‡
10 mg/kg IV every 8 hours		 Evidence II-2 or III*

  • In disseminated disease IV therapy should be given for at for at least 7 days, but may need to be given for longer in patients with extensive involvement or CNS disease

  • Ophthalmology consultation is recommended for patients with ophthalmic involvement

  • Consideration for switch to oral therapy dependent on patient's clinical status
*

Data supporting IV therapy for herpes zoster ophthalmicus and oticus are Evidence level III

†

FDA approved dosing for children only in varicella not herpes zoster

‡

Higher dosing [20mg/kg IV every 8 hours] has been suggested for treatment of herpes zoster in children <12 years (reference 31)