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Question 734
Obstetric infection → Viral
Classification
Question
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Aciclovir dose for varicella post-exposure prophylaxis
Question Stem
A non-immune pregnant woman requires oral aciclovir as first-line post-exposure prophylaxis following significant chickenpox exposure. Which regimen is recommended in the guideline?
Options
A
Aciclovir 200 mg once daily
B
Aciclovir 400 mg twice daily
C
Aciclovir 400 mg three times daily
D
Aciclovir 800 mg twice daily
E
Aciclovir 800 mg four times daily
Explanation
The recommended oral aciclovir dose for varicella post-exposure prophylaxis is 800 mg four times daily. PEP is given from day 7 to day 14 after exposure. Oral valaciclovir is an alternative, particularly when adherence to the aciclovir regimen is a concern, although there are more pregnancy safety data for aciclovir.
Option Validity
A) this dose is substantially below the recommended PEP regimen.
B) 400 mg twice daily is not the recommended varicella PEP dose.
C) 400 mg three times daily is not the recommended regimen.
D) the recommended 800 mg regimen is given four times daily, not twice daily.
Further Reading
RCOG Green-top Guideline No. 13, Chickenpox in Pregnancy, section 4.3.