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Previous Volume 330:896-900 March 31, 1994 Number 13 Next

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ABSTRACT

Background Acyclovir given for 7 to 10 days is of proved benefit in acute herpes zoster, but studies of its effectiveness in preventing postherpetic neuralgia have had conflicting results. The role of corticosteroids in the treatment of herpes zoster is also controversial.

Methods We conducted a double-blind, controlled trial in patients with acute herpes zoster to determine whether either 21 days of acyclovir therapy or the addition of prednisolone offered any improvement over 7 days of acyclovir therapy. Patients with a rash of less than 72 hours' duration were assigned to receive acyclovir (800 mg orally, five times daily) for 7 days with either prednisolone or placebo, or acyclovir for 21 days with either prednisolone or placebo. Prednisolone therapy was initiated at a dose of 40 mg per day and tapered over a three-week period. Patients were assessed frequently through day 28 and then monthly through month 6 to assess postherpetic neuralgia.

Results Of 400 patients recruited, 349 completed the study. No significant differences were detected between the four groups in the progression of the rash (P>0.1). With steroid therapy, a significantly higher proportion of the rash area had healed on days 7 and 14 (P = 0.02). Pain reduction was greater during the acute phase of disease in patients treated with steroids or 21 days of acyclovir (P<0.01 and P = 0.02, respectively, on day 7; P<0.01 for steroid therapy on day 14). However, on follow-up there were no significant differences between any of the groups in the time to a first or a complete cessation of pain. The steroid recipients reported more adverse events.

Conclusions In acute herpes zoster, treatment with acyclovir for 21 days or the addition of prednisolone to acyclovir therapy confers only slight benefits over standard 7-day treatment with acyclovir. Neither additional treatment reduces the frequency of postherpetic neuralgia.

Source Information

From the Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, Birmingham (M.J.W.); the Sir Humphry Davy Department of Anaesthesia, Bristol Royal Infirmary, Bristol (R.W.J.); the Department of Infectious Diseases and Medicine, Royal Hallamshire Hospital, Sheffield (M.W.M.); the Wellcome Research Laboratories, Beckenham (J.T., J.C.); and the Department of Infectious Diseases and Tropical Medicine, Monsall Hospital, Manchester (B.K.M.) -- all in the United Kingdom. Presented in part at the meeting "Herpes -- a Global Challenge," sponsored by the Wellcome Foundation, Ltd., Berlin, Germany, June 4-6, 1992.

Address reprint requests to Dr. Wood at the Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, Bordesley Green E., Birmingham B9 5ST, United Kingdom.

Full Text of this Article

Related Letters:

Acyclovir for Herpes Zoster
van den Broek P. J., Stuyt P. M.J., van der Meer J. W.M., Tangeman J. C., Kuzminski A. M., Svahn D. S., Wood M. J., McKendrick M. W., Johnson R. W.
Extract | Full Text  
N Engl J Med 1994; 331:481, Aug 18, 1994. Correspondence

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