Herpes zoster management in primary care: antiviral indications?

In primary care, antiviral treatment for herpes zoster is indicated for:

• People who are immunocompromised, with consideration for clinical judgment regarding the severity of immunosuppression, rash localization, eye involvement, systemic illness, and ability for close follow-up. Severely immunocompromised individuals should be referred for intravenous aciclovir.
• People aged 50 years and over.
• People with non-truncal involvement, excluding the head and neck, which warrant admission or specialist advice.
• People experiencing moderate to severe pain or a moderate to severe rash.
• People with predisposing skin conditions.
• Antiviral treatment can be considered for individuals under 50 years with shingles affecting the extremities or trunk, based on clinical judgment.
• Treatment can be initiated up to one week after rash onset if not possible within 72 hours, particularly for those at higher risk of severe disease or complications.
• Antiviral treatment is not recommended for immunocompetent children.
• For pregnant or breastfeeding women with shingles, specialist advice should be sought before prescribing antiviral treatment.