Herpes simplex virus and varicella-zoster virus prophylaxis in immunocompromised adults without HIV infection

This section includes regimens for antiviral prophylaxis against herpes simplex virus (HSV) and varicella-zoster virus (VZV) infection in immunocompromised adults without HIV infection. To assess if HSV and VZV antiviral prophylaxis is indicated, see Assessing the need for antimicrobial prophylaxis in immunocompromised adults without HIV infection. HSV and VZV prophylaxis is not required in patients already receiving valganciclovir or ganciclovir for cytomegalovirus prophylaxis.

Note: HSV and VZV prophylaxis is not required in patients receiving valganciclovir or ganciclovir for cytomegalovirus prophylaxis.

For HSV and VZV antiviral prophylaxis, use:

valaciclovir 500 mg orally, 12-hourly. For dosage adjustment in adults with kidney impairment, see valganciclovir prophylaxis dosage adjustment. For duration of prophylaxis, see Assessing the need for antimicrobial prophylaxis in immunocompromised adults without HIV infection. hsv and vzv prophylaxis (immunocompromised adult without HIV) valaciclovir    

If the patient is unable to tolerate or absorb oral therapy, use:

aciclovir 5 mg/kg intravenously, 8-hourly1. For dosage adjustment in adults with kidney impairment, see aciclovir intravenous dosage adjustment. Switch to oral valaciclovir (see dosage above) when possible. For duration of prophylaxis, see Assessing the need for antimicrobial prophylaxis in immunocompromised adults without HIV infection. hsv and vzv prophylaxis (immunocompromised adult without HIV) aciclovir    

For varicella-zoster virus immunisation recommendations, see the Australian Immunisation Handbook [URL].

1 Aciclovir dosing in obesity is poorly defined; however, limited data support dosing based on adjusted body weight in adults and ideal body weight in children. For simplicity, some centres recommend a maximum dosing weight of 100 kg (eg 1 g for 10 mg/kg doses, 1.5 g for 15 mg/kg doses).Return