Considering antivirals

For early cases of shingles, a course of oral aciclovir or valaciclovir may be used. There is evidence that the earlier treatment is started within 72 hours of rash onset, the more it may reduce the severity and duration of a shingles episode. Pharmacists are now able to initiate this early treatment. Community pharmacy PGDs, for example in Scotland, make more specific requirements for treatment initiation, usually relating to restricting it to within 72 hours of onset, to those with a single affected dermatome on the torso and in patients aged over 18 years.

In England, both the aciclovir and valaciclovir PGDs list patient inclusion criteria as a diagnosis of shingles within 72 hours of rash onset AND ANY of the following:

• Non-truncal involvement (e.g. shingles affecting the neck, limbs or perineum)
• Moderate or severe pain
• Moderate or severe rash (defined as confluent lesions)
• Aged over 50 years.