Herpes zoster – is there a need for new treatment recommendations?

Uroš  Karić; Nataša Katanić; Sanja Peruničić; Nikola Mitrović; Nataša Nikolić; Marko Marković; Ksenija Bojović; Jovan Malinić; Jasmina Poluga; Jasmina Simonović Babić

doi:10.2298/VSP170905021K

Uroš Karić Clinical Center of Serbia, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia University of Priština/ Kosovska Mitrovica, Faculty of Medicine, Kosovska Mitrovica, Serbia
Nataša Katanić Clinical Center of Serbia, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia
Sanja Peruničić Clinical Center of Serbia, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia
Nikola Mitrović Clinical Center of Serbia, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia
Nataša Nikolić Clinical Center of Serbia, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia
Marko Marković Clinical Center of Serbia, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia
Ksenija Bojović Clinical Center of Serbia, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia
Jovan Malinić Clinical Center of Serbia, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia
Jasmina Poluga Clinical Center of Serbia, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia
Jasmina Simonović Babić Clinical Center of Serbia, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia; University of Beograde, Faculty of Medicine, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP170905021K

Keywords: varicella zoster virus infection, recurrence, drug users, treatment outcome

Abstract

Abstract

Background/Aim. The reactivation of the varicella zoster virus results in herpes zoster. Acyclovir is currently recommended over 7 to 10 days for herpes zoster treatment and should be started within 72 hours of rash eruption. This study analyses whether a therapy delay and/or shorter courses of treatment are associated with adverse outcomes. Methods. We identified 292 patients treated at the Clinic for Infectious and Tropical Diseases in Belgrade for herpes zoster in a five-years period. The data on these patients were analyzed using the descriptive statistics, the χ² test, the Mann-Whitney U-test and the multiple logistic regression analysis. Results. The average time from rash eruption to the first dose of acyclovir was 4.07 ± 2.64 days. The patients received acyclovir for 6.83 ± 2.45 days. Seventy-one patients had disseminated herpes zoster, 100 had cranial nerve involvement, 86 had complications other than postherpetic neuralgia and one patient died. In cases where therapy was delayed there was no significant association with complications (χ² = 0.031; p = 0.86). Our logistic regression model was not able to predict who was treated less than 7 days. An association between the HZ complications and abbreviated acyclovir regimens was not demonstrated (χ² = 1.109; p = 0.326). We conducted the PubMed search on February 1st, 2017 and found no proof for the need to apply at least 7 days of acyclovir therapy for herpes zoster in the studies that have been published so far. Conclusion. We were unable to prove an association between therapy delay and unfavorable outcomes. The same was true for shorter than recommended acyclovir courses.

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