Acyclovir use uncertain in children with chickenpox

There seems to be little value in using acyclovir to treat children with chickenpox who are otherwise healthy.

While many different antibiotics that tackle bacteria have been around for decades, it is only more recently that a few anti-virals have started to appear on the market. One is acyclovir. A systematic review, which identified three relevant clinical studies involving a total of 988 patients, concluded it should not be used routinely in children with chickenpox.

When given within 24 hours of the rash starting to appear, acyclovir can shorten the length of time a child experiences a fever and can reduce the number of large spots. It doesn’t however reduce the length of the illness, or the total number of spots (large and small). It also doesn’t reduce itchiness or reduce the risk of complications.

If it is given more than 24 hours after onset the effect is much less, and in practice it is very difficult to give the drug that early.

“The data at the moment show that acyclovir confers at best only modest benefits for a disease that is self-limiting and has few complications in otherwise healthy children,” says lead Cochrane Review Author Terry Klassen, from the Department of Pediatrics, at the University of Alberta, Edmonton, Canada.

Consequently giving it is not cost-effective, because the small reduction in symptoms does not remove any other cost from the task of caring for the patient, nor does it remove the cost of secondary complications.