Education And Debate

Controversies in Management: Acyclovir for childhood chickenpox

BMJ 1995; 310 doi: (Published 14 January 1995) Cite this as: BMJ 1995;310:108
  1. M W McKendrick, consultant physiciana
  1. a Department of Infectious Diseases and Medicine, Royal Hallamshire Hospital, Sheffield S10 2JF

    Cost is unjustified

    Chickenpox is usually a disease of childhood, but it can occur at any age. In Sheffield (population 500000) about one immunocompetent patient a year requires admission to the intensive care unit for chickenpox pneumonia, and there has been one death in the past 12 years (unpublished observations). Pneumonia is a rare complication in children, in whom the disease is usually mild and uncomplicated. But in immunocompromised patients, including infants acquiring infectionperinatally and patients taking steroids, the illness can be severe, and antiviral drugs may be life saving.

    Mortality figures from the United States suggest an overall death rate from chickenpox of about one in 40000, though for patients aged over 19 years the rate is one in 1460.1 Severe infection with chickenpox in childhood is rare. One of the commonest causes of death was Reye's syndrome, but this should now be less common as its association with aspirin has been recognised and aspirin is not given to children. Death due to chickenpox or its complications is very rare in immunocompetent children.

    In 1935 Bullowa and Wishik observed that chickenpox is the disease of childhood which is taken least seriously by the general public and by the medical profession.2 Children with secondary infection from someone in their …

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