Zoster in Immunosuppression — SCE Rheumatology MCQ
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Correct answer: E — Oral Aciclovir or Valaciclovir should be started within 72 hours of rash onset
Immunosuppressed patients with herpes zoster should receive antiviral therapy (oral Aciclovir 800 mg 5 times daily for 7 days or Valaciclovir 1 g TDS for 7 days) ideally within 72 hours of rash onset though later initiation may still benefit immunosuppressed patients. IV Aciclovir is reserved for disseminated zoster ophthalmic zoster or immunocompromised patients with severe disease. Immunosuppression should be reviewed and may need temporary dose reduction. Vaccination with Shingrix (recombinant non-live) should be considered after the acute episode resolves to prevent recurrence.
Reference: BSR 2019 biologic safety guidelines; NICE CKS Shingles; BNF Aciclovir dosing