Herpes Zoster Not Responding to Acyclovir After 10–21 Days: What to Do Next
When a patient with herpes zoster shows no adequate response despite a full course of acyclovir spanning 10 to 21 days, acyclovir resistance should be considered. This situation calls for a reassessment of the antiviral strategy.
Clinical Scenario
Clinically, VZV infections that do not respond to acyclovir treatment administered for 10 to 21 days may be considered to be acyclovir resistant. Identifying this pattern early is essential for redirecting management appropriately.
Treatment Approach (partial)
In this setting, a switch to an alternative antiviral agent belonging to a different mechanistic class may be appropriate — the full protocol specifies the agents and approach.
Full regimen details, agent selection, and clinical decision pathway available in the complete protocol.
References
DOI: 10.1111/ddg.14013
Clinically, VZV infections that do not respond to acyclovir treatment administered for 10 to 21 days may be considered to be acyclovir resistant.
In cases of acyclovir resistance, treatment with an alternative antiviral agent, for example, brivudine, or with another thymidine kinase-dependent antiviral agent (famciclovir) may be attempted.
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