by Robert Steele, MD (see more from this expert)

Q

Would you prescribe Zovirax/Acyclovir for chicken pox for a three-year-old healthy girl whose biological mother scars extremely easily? I have a 3/4" x 2" raised scar on abdomen from appendectomy at age five and deep chicken pox scars from childhood.



A

Acyclovir (tradename Zovirax) is a drug which disrupts replication of the DNA of the chicken pox virus. When the DNA can't replicate, neither can the virus. Studies have shown that early use of Acyclovir (started within the first 24 hours of the rash) does seem to modify the symptoms of the infection but only modestly.

What Acyclovir does:

  1. Decreases the number of chicken pox lesions. The number of lesions goes down a little bit but is certainly not eliminated.
  2. Decreases the length of time new lesions show up.
  3. Decreases the number of days children have a fever. The fever goes away about one day earlier with acyclovir.

What Acyclovir does not do:

  1. It does not decrease the complications of chicken pox (e.g. infected skin lesions)
  2. It does not make the person less infectious to other people since the most infectious period of chicken pox occurs before the rash shows up.
  3. It does not seem to lower the immunity to chicken pox after the infection. However, the long term effects acyclovir has on immunity are still being studied.

By the time a child with chicken pox comes to see the pediatrician, the rash has usually been there for more than 24 hours making the decision for acyclovir moot. However, with that scenario aside, the decision to use acyclovir should not be routine but rather should be a joint one between the doctor and parent based upon the pros and cons. This drug must be given 4 times per day and costs anywhere between $200-270 for a five day course.

If your child scars as easily as yourself, this may be well worth it. However, for many, especially those without insurance, the modest, if any, effects acyclovir has on the individual child's symptoms may not be as enticing.

There are a few types of patients that I would recommend using acyclovir because the symptoms of the disease may be more severe. These include:

  1. Non-pregnant individuals over the age of 13
  2. Those people taking aspirin on achronic basis
  3. Those people taking anti-inflammatory steroids for any number of conditions including asthma.
  4. Immune suppressed individuals (e.g. patients with cancer, AIDS, etc.)