Acyclovir resistance has been described in VZV isolates from patients with HIV infection who received long-term acyclovir therapy. Foscarnet is the drug of choice for acyclovir-resistant VZV infections in immunocompromised hosts. Acyclovir is also effective in reducing the severity and shortening the course of chicken pox in both children and adults who are immunologically competent. Whether all children and adults with chicken pox should receive acyclovir is a source of controversy. The utility of corticosteroids in the management of acute herpes zoster is controversial.
Postherpetic neuralgia is difficult to treat, particularly in elderly patients.
High-dose oral acyclovir does not appear useful for the management of postherpetic neuralgia. Other forms of treatment of postherpetic neuralgia include analgesics, amitriptyline, and levodopa.