What criteria should I use to determine if a patient with chickenpox requires antiviral treatment?

Antiviral treatment for chickenpox should be considered based on the following criteria:

• Adults or adolescents (aged 14 years or older) who are immunocompetent and present within 24 hours of rash onset, especially if they have severe chickenpox or are at increased risk of complications such as smokers or those with severe lung or cardiovascular disease, or chronic skin disorders, should be considered for oral aciclovir 800 mg five times daily for 7 days.
• Pregnant women, particularly those 20 weeks gestation or more, presenting within 24 hours of rash onset, should be offered a 7-day course of oral aciclovir after informed consent and specialist advice, due to increased risk of serious complications.
• Intravenous aciclovir is indicated if chickenpox is severe or complicated, regardless of pregnancy status.
• Otherwise healthy children with uncomplicated chickenpox generally do not require antiviral treatment; symptomatic care is recommended.
• Antiviral treatment is more likely to be beneficial if started within 24 hours of rash onset; starting treatment after 24 hours has not shown significant benefit in reducing lesion crusting time or new lesion formation.

These criteria aim to reduce complications and severity in higher-risk groups while avoiding unnecessary antiviral use in low-risk patients.

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