Shingles antiviral timing — GPhC CRA MCQ

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ModerateInfectionsShingles antiviral timingGPhC CRA

A 72-year-old develops a painful unilateral vesicular rash in a thoracic dermatome 30 hours ago. The eye is not involved and there are no neurological symptoms. What should the pharmacist do?

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Correct answer: B — Arrange same-day oral antiviral assessment within the 72-hour treatment window

Arrange same-day oral antiviral assessment within the 72-hour treatment window: Older age increases complication risk and oral antivirals are most effective when started within 72 hours of rash onset. Use topical aciclovir and arrange review if lesions reach the eye: Topical antiviral treatment is inadequate and systemic treatment is indicated beyond ophthalmic disease in higher-risk adults. Review after vesicle formation stops and then consider oral antiviral treatment: Waiting can move the patient outside the optimal antiviral window. Use a corticosteroid dressing and review pain after three treatment days: Occlusion and topical corticosteroid monotherapy do not treat varicella-zoster replication. Treat possible cellulitis with an oral antibiotic and routine follow-up: The unilateral vesicular dermatomal presentation is characteristic of herpes zoster rather than cellulitis.

Reference: BNF: aciclovir: https://bnf.nice.org.uk/drugs/aciclovir/; NHS England Pharmacy First service specification and clinical pathways: https://www.england.nhs.uk/publication/community-pharmacy-advanced-service-specification-nhs-pharmacy-first-service/