Recommendations for the management of herpes zoster

Dworkin, Robert H.; Johnson, Robert W.; Breuer, Judith; Gnann, John W.; Levin, Myron J.; Backonja, Miroslav; Betts, Robert F.; Gershon, Anne A.; Haanpää, Maija L.; McKendrick, Michael W.; Nurmikko, Turo J.; Oaklander, Anne Louise; Oxman, Michael N.; Langston, Deborah Pavan; Petersen, Karin L.; Rowbotham, Michael C.; Schmader, Kenneth E.; Stacey, Brett R.; Tyring, Stephen K.; Wijck, Albert J. M. van; Wallace, Mark S.; Wassilew, Sawko W.; Whitley, Richard J.

doi:10.1086/510206

Cited by 869Herpesvirus Infections and TreatmentsCytomegalovirus and herpesvirus researchViral Infections and Immunology Research

Recommendations for the management of herpes zoster

Dworkin, Robert H., Johnson, Robert W., Breuer, Judith, Gnann, John W., Levin, Myron J., Backonja, Miroslav, Betts, Robert F., Gershon, Anne A. +15 more·2007·Clinical Infectious Diseases

DOI 10.1086/510206

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Abstract

The objective of this article is to provide evidence-based recommendations for the management of patients with herpes zoster (HZ) that take into account clinical efficacy, adverse effects, impact on quality of life, and costs of treatment. Systematic literature reviews, published randomized clinical trials, existing guidelines, and the authors' clinical and research experience relevant to the management of patients with HZ were reviewed at a consensus meeting. The results of controlled trials and the clinical experience of the authors support the use of acyclovir, brivudin (where available), famciclovir, and valacyclovir as first-line antiviral therapy for the treatment of patients with HZ. Specific recommendations for the use of these medications are provided. In addition, suggestions are made for treatments that, when used in combination with antiviral therapy, may further reduce pain and other complications of HZ.

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VZV meningoencephalitis would be the only indication for modifying antiviral therapy (intravenous instead of oral) for VZV infection.
“This situation would be the only indication for modifying antiviral therapy (intravenous instead of oral) for VZV infection (31).”
From Utilization of a Meningitis/Encephalitis PCR panel at the University Hospital Basel – a retrospective study to develop a diagnostic decision rule (2024) · cites this paper as [31]
The Neurologic complications of HZ section recommends intravenous acyclovir for meningitis and encephalitis, but also for myelitis. The Treatment of Immunocompromised Patients section recommends it for severely immunocompromised patients and transplant recipients with suspected visceral dissemination. Meningoencephalitis is therefore not the only indication given in the source; page numbers were not provided in our copy. (LLM, conf=0.90)
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Shingles without neurological involvement may cause pleocytosis as well as VZV-DNA detection in CSF.
“It was shown that shingles without neurological involvement may cause pleocytosis as well as VZV-DNA detection in CSF (29–31).”
From Utilization of a Meningitis/Encephalitis PCR panel at the University Hospital Basel – a retrospective study to develop a diagnostic decision rule (2024) · cites this paper as [31]

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Authors: Dworkin, R. H., Johnson, R. W., Breuer, J., Gnann, J. W., Levin, M. J., Backonja, M., Betts, R. F., Gershon, A. A., Haanpää, M. L., McKendrick, M. W., Nurmikko, T. J., Oaklander, A. L., Oxman, M. N., Langston, D. P., Petersen, K. L., Rowbotham, M. C., Schmader, K. E., Stacey, B. R., Tyring, S. K., Wijck, A. J. M. V., Wallace, M. S., Wassilew, S. W., & Whitley, R. J.
Affiliations: University of Rochester Medicine (US)
University of Bristol (GB)
Queen Mary University of London (GB)
Birmingham VA Medical Center (US)
University of Colorado Denver (US)
Columbia University (US)
Helsinki University Hospital (FI)
Royal Hallamshire Hospital (GB)
University of Liverpool (GB)
Harvard University (US)
University of California San Diego (US)
University of California, San Francisco (US)
Duke University (US)
The University of Texas Health Science Center at Houston (US)
Utrecht University (NL)
Helios Klinikum Krefeld (DE)
University of Alabama at Birmingham (US)
Corresponding author: Dworkin, Robert H.
ORCID: Dworkin, Robert H.
Johnson, Robert W.
Breuer, Judith
Levin, Myron J.
Gershon, Anne A.
Haanpää, Maija L.
Nurmikko, Turo J.
Oaklander, Anne Louise
Petersen, Karin L.
Schmader, Kenneth E.
Tyring, Stephen K.
Wijck, Albert J. M. van
Wallace, Mark S.
Whitley, Richard J.
Venue: Clinical Infectious Diseases
Publisher: Oxford University Press (OUP)
Published: 2007-01-01
Volume: 44
Issue: Supplement_1
Pages: S1-S26
ISSN: 1058-4838 (ISSN-L)
1537-6591
DOI: 10.1086/510206
OpenAlex: W2104761404
Cited by: 869
References: 253
Citations by year: 2026: 34 · 2025: 39 · 2024: 48 · 2023: 51 · 2022: 51 · 2021: 46 · 2020: 46 · 2019: 37 · 2018: 48 · 2017: 52 · 2016: 43 · 2015: 46 · 2014: 50 · 2013: 52 · 2012: 43
FWCI: 24.59
Type: journal article
Language: en
Open access: closed
Locations: Clinical Infectious Diseases (publishedVersion)
PubMed (publishedVersion)
UCL Discovery (University College London) (submittedVersion)
HighWire Press Open Archive (submittedVersion)
Topics: Health Sciences › Medicine › Epidemiology › Herpesvirus Infections and Treatments
Health Sciences › Medicine › Epidemiology › Cytomegalovirus and herpesvirus research
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
Keywords: herpes zoster, antiviral therapy, acyclovir, brivudin, famciclovir, valacyclovir, first-line therapy, postherpetic neuralgia, treatment guidelines, treatment costs, quality of life
MeSH terms: Valacyclovir, Famciclovir, Acyclovir, Analgesics, Anti-Inflammatory Agents, Antiviral Agents, Bromodeoxyuridine, Herpes Zoster, Humans, Immunocompetence, Valine, Herpesvirus 3, Human, 2-Aminopurine, Immunocompromised Host

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