# Varicella (chickenpox) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: NICE CKS Chickenpox 2021 · MSF Essential Drugs 2024 - paracetamol (oral) · Egyptian National Drug Formulary - Antimicrobial 2023 (acyclovir monograph) - Verified date: 2026-08 ## Verified against - MSF Essential Drugs 2024 - paracetamol (oral) - Egyptian National Drug Formulary - Antimicrobial 2023 (acyclovir monograph) - Varicella-Zoster Virus (Chickenpox) - disease-level clinical article (chickenpox-clinical.txt) ## Treatment metadata - Paracetamol — 500 mg — oral.solid - Referral & safety-netting (no drug therapy) - Acyclovir — 800 mg — oral.solid ## Complete treatment card ```text VARICELLA (CHICKENPOX) Sources: NICE CKS Chickenpox 2021 · MSF Essential Drugs 2024 - paracetamol (oral) · Egyptian National Drug Formulary - Antimicrobial 2023 (acyclovir monograph) Review status: REVIEWED against MSF Essential Drugs 2024 - paracetamol (oral), Egyptian National Drug Formulary - Antimicrobial 2023 (acyclovir monograph), Varicella-Zoster Virus (Chickenpox) - disease-level clinical article (chickenpox-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (8) - Adolescents and adults often have a prodrome of muscle aches, nausea, poor appetite and headache before the rash [headache · muscle pain · nausea · poor appetite · rash] - Children can skip the prodrome entirely, with the rash or mouth lesions as the first sign [rash] - Itching is intense once lesions reach the blister stage [blisters · itching] - Painful, itchy oral and tonsil ulcers can show up 1 to 3 days before the skin rash [itching · rash] - Adults tend to get a more widespread rash with a longer fever, and pneumonia is their most serious complication [fever · rash] - Fever, tiredness, sore throat and headache come with the rash and usually run 5 to 7 days [fatigue · fever · headache · rash · sore throat] - Illness starts 10 to 21 days after exposure, about a fortnight on average - The child is infectious from a day or two before the rash until every lesion has crusted over [crusting · rash] SIGNS - what you find (6) - An itchy, red macular and papular eruption starts on the head and face, then spreads to the trunk and limbs [itching · papules · rash] - Within about 12 hours the lesions turn into 1 to 3 mm clear vesicles ringed by a thin red halo, the classic dew-drop look [blisters · vesicles] - The distal limbs and lower extremities are commonly spared - Seeing lesions at every stage of development at once - macular through crusted - is characteristic of this disease [crusting · rash] - Vesicles can appear on the palms, soles and genital area, and often involve the oral mucosa [blisters · vesicles] - The total number of vesicles can range from just a few up to several hundred [blisters · vesicles] TESTS (6) - Diagnosis rests mainly on the clinical picture, confirmed if needed by vesicle fluid exam, scraping an uncrusted lesion, or blood testing for an acute immune response - PCR gives the highest diagnostic yield and can be run on nonskin samples like bronchoalveolar lavage or CSF - Direct fluorescent antibody testing has largely taken over from the older Tzanck smear - Culturing the vesicle fluid is possible but gives a lower yield than PCR - Serology can separate acute infection (IgM) from past infection and lasting immunity (IgG) - Fetal varicella can be assessed by ultrasound, ideally waiting about 5 weeks after the mother's infection IF NOT THIS - what else fits (3) - Monkeypox and smallpox share fever, rash, myalgia, chills and headache with this illness but can be distinguished - Monkeypox lesions all sit at the same stage together, unlike the mixed-stage lesions seen here - Other mimics include drug eruptions, scabies, rickettsialpox, bullous insect bite reactions, disseminated herpes simplex infection, coxsackievirus-related eruptions, and pityriasis lichenoides et varioliformis acuta Source StatPearls "Varicella-Zoster Virus (Chickenpox)" - disease-level clinical article Status traced to the source above 1. PARACETAMOL [1st line] Adult 1 g 3 or 4 times daily (max. 4 g daily) Peds 15 mg/kg/dose [child max 500 mg] (15 mg/kg per dose every 4-6 hours (max 60 mg/kg/day) Under 1 month: 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg/day (MSF Essential Drugs 2024).) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 - paracetamol (oral) Why Antipyretic and analgesic used for fever and discomfort in chickenpox; chosen over an NSAID such as ibuprofen, which is avoided here because of its association with severe secondary skin and soft-tissue infection. Caution STRICTLY AVOID NSAIDs (ibuprofen) in chickenpox due to risk of necrotizing soft tissue infections. Do not exceed maximum daily paracetamol dose (hepatotoxicity risk). Keep child isolated until all vesicles have crusted over. 500 mg is the per-dose ceiling used here for a child. 1000 mg is the adult dose and does not belong in a weight calculation - the daily 60 mg/kg limit is the one that binds first in any case. Administer with caution to patients with hepatic impairment. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Varicella-Zoster Virus (Chickenpox) - disease-level clinical article (chickenpox- clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Avoid aspirin in children due to the risk of Reye syndrome. RED FLAG - Passive prophylaxis with varicella zoster immune globulin is used for high- risk nonimmune populations (pregnant women, immunocompromised, high-risk neonates). 3. ACYCLOVIR [2nd line] Adult 800 mg orally 5 times daily (every 4 hours while awake) - ≥5 to 7 days and until all lesions have crusted Peds 20 mg/kg/dose [child max 800 mg] (20 mg/kg 4 times daily (maximum 80 mg/kg daily) for 5 days in those weighing ≤40 kg and 800 mg 4 times daily for 5 days in those weighing >40 kg) 3kg -> 60 mg/dose 4kg -> 80 mg/dose 5kg -> 100 mg/dose 6kg -> 120 mg/dose 7kg -> 140 mg/dose 8kg -> 160 mg/dose 9kg -> 180 mg/dose 10kg -> 200 mg/dose 11kg -> 220 mg/dose 12kg -> 240 mg/dose 13kg -> 260 mg/dose 14kg -> 280 mg/dose 15kg -> 300 mg/dose 16kg -> 320 mg/dose 17kg -> 340 mg/dose 18kg -> 360 mg/dose 19kg -> 380 mg/dose 20kg -> 400 mg/dose 21kg -> 420 mg/dose 22kg -> 440 mg/dose 23kg -> 460 mg/dose 24kg -> 480 mg/dose 25kg -> 500 mg/dose 26kg -> 520 mg/dose 27kg -> 540 mg/dose 28kg -> 560 mg/dose 29kg -> 580 mg/dose 30kg -> 600 mg/dose 31kg -> 620 mg/dose 32kg -> 640 mg/dose 33kg -> 660 mg/dose 34kg -> 680 mg/dose 35kg -> 700 mg/dose 36kg -> 720 mg/dose 37kg -> 740 mg/dose 38kg -> 760 mg/dose 39kg -> 780 mg/dose 40kg -> 800 mg/dose 41kg -> 800 mg/dose (capped) 42kg -> 800 mg/dose (capped) 43kg -> 800 mg/dose (capped) 44kg -> 800 mg/dose (capped) 45kg -> 800 mg/dose (capped) 46kg -> 800 mg/dose (capped) 47kg -> 800 mg/dose (capped) 48kg -> 800 mg/dose (capped) 49kg -> 800 mg/dose (capped) 50kg -> 800 mg/dose (capped) Source Egyptian National Drug Formulary - Antimicrobial 2023 (acyclovir monograph) Why Antiviral that inhibits varicella-zoster viral DNA replication, shortening the course and reducing complications; reserved for those at higher risk of severe disease such as adults, adolescents, and the immunocompromised, rather than used routinely in healthy young children. Caution Indicated for immunocompromised patients, severe cases, or adults/adolescents. Start within 24 hours of rash onset for maximum clinical benefit. Ensure adequate hydration during oral aciclovir therapy. CrCl 10 to 25 mL/minute/1.73 m2: If the usual recommended dose is 800 mg 5 times daily: Administer 800 mg every 8 hours Egypt VIRUSTAT 800MG 35 TAB. PHAROPHARMA 266.00 EGP (7.60/unit) ACIVIRAX 800MG 20 TABS. MASH PREMIERE 154.00 EGP (7.70/unit) LOVIR 800 MG 35 ORAL DISP. TABS. SUN PHARMA EG... 300.00 EGP BORGAVIRAX 200MG/5ML SUSP. 125 ML BORG 61.00 EGP -> ? strength differs, ? different route - not oral solid VIRUSTAT 200MG/5ML SUSP. 120 ML PHAROPHARMA 61.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)