Herpes Zoster / Disseminated HSV or VZV in the Immunocompromised

Clinical features

• Vesicular lesions affecting multiple dermatomes

Investigations

• COPAN swab from de-roofed blister
• If systemically unwell, consider blood culture
• Consider HIV testing

Infection Control

• Isolate with contact precautions
• Do not place patient in V34 or V44
• Pregnant staff should avoid caring for the patient

Infectious from 2 days before appearance of rash and until all lesions have crusted

Treatment

ACICLOVIR IV 10mg/kg 8 hourly 

For obese patients (BMI ≥30kg/m²) dose according to adjusted body weight rather than ideal body weight (IBW) 

Adjusted body weight = (0.4 x [total body weight – IBW] ) + IBW 

Dosing interval may require adjustment if CrCl <50ml/min – see BNF for further information 

 

For patients showing a good response, consider IVOS to:

ACICLOVIR PO

800mg 5 times per day

Duration: 5 days total OR until 2 days after last new lesions appear, whichever is longer