Acyclovir therapy for varicella in otherwise healthy children and adolescents

Acyclovir has been approved in the United States and elsewhere as antiviral therapy for otherwise healthy children and adolescents with varicella. This development arose from multicentre placebo-controlled trials of acyclovir in normal patients, 2-18 years of age, which showed that the drug accelerated cutaneous healing, and reduced fever and related constitutional symptoms without harmful side effects. Acyclovir did not, however, decrease transmission of chickenpox within the household, nor was there any demonstrable effect of antiviral therapy on varicella complications. In this article, the background and rationale for the multicentre studies of acyclovir in normal paediatric patients with chickenpox is reviewed. The evidence for and against its routine administration within 24 hours of the eruption of skin rash is also discussed.