Acyclovir for treatment of varicella in immunocompetent patients

Varicella, one of the most common childhood diseases, can cause significant morbidity and even mortality in immunecompetent persons. In the U.S. alone, an estimated 4000-6000 otherwise normal youngsters are hospitalized every year with an annual death rate for immunecompetent persons of 96. This article reviews and updates progress in clinical trials utilizing oral acyclovir for treatment of varicella in immunecompetent patients. Three placebo-controlled, double-blind studies of acyclovir in normal youngsters and adolescents found that the drug reduced the height and duration of fever and accelerated cutaneous healing without producing any adverse effects. Acyclovir did not diminish VZV antibody titers measured one year post-varicella by either ELISA or FAMA methods. A recent study in 148 immunecompetent adults demonstrated that acyclovir can significantly reduce fever and hasten cutaneous healing. Acyclovir is thus of proven benefit for treatment of varicella. The major issue remaining is who should be treated, and the pros and cons of this are discussed.