Commentary: reserve acyclovir for secondary cases

BMJ 1995;310:110 (14 January)

Education and debate

Commentary: reserve acyclovir for secondary cases

Peter C Rubin

Acyclovir is a safe drug that reduces the duration and severityof childhood chickenpox when started within 24 hours of therash appearing. The case for using the drug in children whoare immunocompromised (including those receiving steroids) isunanswerable. But I am not convinced that the drug should beused routinely in all children with chickenpox. The cost wouldbe substantial and out of proportion to the benign course ofmost cases of the disease. Both authors make the point thatsecondary cases within a family are more severe and easier toidentify earlier than the primary case. In an era of limitedhealth care resources it seems more appropriate to reserve acyclovirfor these secondary cases.--PETER C RUBIN, professor of therapeutics,University of Nottingham