Varicella (Chickenpox), Complicated

General measures

Medicine treatment

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ICD-10 code: B01.1-2† + (G02.0*/G05.1*+J17.1*)/B01.8

GENERAL MEASURES

• Cool, wet compresses or tepid water baths.
• Body hygiene to prevent secondary infection.
• Advise against scratching.

MEDICINE TREATMENT

Antiviral therapy is required in complicated cases, e.g.:

• chickenpox pneumonia,
• pregnancy,
• neurological involvement, and
• chickenpox in immunocompromised patients.

Antiviral therapy:

Aciclovir, IV, 10 mg/kg 8 hourly for 7 days.

• Infuse aciclovir over one hour.

For varicella without neurological involvement, when the patient’s clinical condition improves, the 7-day course can be completed with:

• Antiviral (active against varicella zoster), e.g:
• Aciclovir, oral, 800 mg five times daily.
  • Doses are given 4 hourly, except for dose scheduled for the middle of the night.

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Secondary infection
ICD-10 code: B02.8

Treat secondary bacterial infection if suspected.

• Flucloxacillin, oral, 500 mg 6 hourly for 5 days.

OR

• Cefalexin, oral, 500 mg 6 hourly for 5 days.

Passive immunization following significant exposure:
ICD-10 code: (Z29.1)

Criteria for eligibility [Both a) and b) below are required]:
a) Significant exposure - Household contacts exposed to/ patients lying adjacent to (same ward) those diagnosed with varicella.
b) Severe immunological compromise and lack of varicella-directed immunity (i.e. no history of chickenpox/shingles, or negative VZV IgG).

• Varicella-zoster immunoglobulin (VZIG), IM, 125 units/10 kg.
  • Maximum dose: 600 units.
  • Administer within 96 hours of significant exposure.

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Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 1.2_20 January 2025

Chapter 9 Systemic and Healthcare-Associated Infections_9.12 Varicella (Chickenpox), Complicated