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Question 735
Obstetric infection → Viral
Classification
Question
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Valaciclovir dose for varicella post-exposure prophylaxis
Question Stem
A non-immune pregnant woman requires post-exposure prophylaxis after significant chickenpox exposure. Adherence to a four-times-daily aciclovir regimen is likely to be difficult. Which oral valaciclovir regimen is described as an alternative?
Options
A
250 mg once daily
B
500 mg twice daily
C
500 mg three times daily
D
1000 mg three times daily
E
2000 mg once daily
Explanation
Oral valaciclovir 1000 mg three times daily is an alternative PEP regimen. Valaciclovir is a prodrug of aciclovir with better bioavailability and requires fewer daily doses. Aciclovir remains preferred because more pregnancy safety data are available, but valaciclovir may be considered when adherence to the aciclovir dosage schedule is problematic.
Option Validity
A) 250 mg once daily is not the recommended PEP regimen.
B) 500 mg twice daily is not the regimen described in the guideline.
C) the recommended valaciclovir dose is higher.
E) the guideline specifies divided three-times-daily dosing rather than 2000 mg once daily.
Further Reading
RCOG Green-top Guideline No. 13, Chickenpox in Pregnancy, section 4.3.