Pediatrics MOC Sample Questions

The correct answer is D. Acyclovir and varicella zoster immune globulin

Explanation: Varicella-zoster virus (VZV) causes chickenpox and herpes zoster (shingles). Chickenpox follows initial exposure to the virus and is typically a relatively mild, self-limited childhood illness with a characteristic exanthem, but can become disseminated in immunocompromised children. Several studies indicate that antiviral medications decrease the duration of symptoms and the likelihood of postherpetic neuralgia, especially when initiated within 2 days of the onset of rash. In typical cases that involve individuals who are otherwise healthy, oral acyclovir may be prescribed. An important study by Kubeyinje (1997) suggested that the use of acyclovir in healthy young adults with zoster is not clearly justified, especially in situations of limited economic resources. Only Acyclovir is available in intravenous form.

Treatment regimens for varicella zoster in pediatric patients are as follows: Adults and children >12 years at increased risk for complications: Acyclovir 800 mg PO 5 times daily x 5-7 days.

Children >1 year who have encephalitis or pneumonia or are immunocompromised: Acyclovir 500 mg/m2 IV q8h for 7-10 days.

Children 2-12 years who are at increased risk for complications: Acyclovir 20 mg/kg PO 4 times daily for 5 days; not to exceed 3200 mg/day.

Children < 1 year who are immunocompromised: 30 mg/kg/day IV in 3 divided doses for 7-10 days.

Children 2-12 years with uncomplicated varicella: Use of acyclovir is not routinely recommended.

Varicella zoster immune globulin (VariZIG by Cangene) is indicated for administration to high-risk individuals within 10 days (ideally within 4 days) of chickenpox (varicella zoster virus) exposure. High-risk groups include: Immunocompromised children and adults, newborns of mothers with varicella shortly before or after delivery, premature infants, infants less than one year of age, adults without evidence of immunity and pregnant women.