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To children, the most common victims of chickenpox, the tell-tale spots sadly mean discomfort and a lot of itching. They also mean missing about a week of school--not a bad tradeoff in the eyes of some grade-schoolers.
But for parents, natural concern over the chickenpox- infected child's well-being is increasingly accompanied by an economic burden--missed school days often equal days missed from work or require special child care arrangements.
The results of a multi-center drug study announced this week, however, may soon lead to faster chickenpox relief for both children and parents. Researchers at 10 institutions found that acyclovir, a drug used primarily for treating herpes simplex infections in adults, "is a safe and effective treatment for chickenpox in normal children when therapy is initiated during the first 24 hours of rash," according to a report in the November 28 issue of the New England Journal of Medicine.
The drug is currently being considered for approval as a chickenpox treatment by the U.S. Food and Drug Administration, explained Dr. Ann Arvin, Stanford professor of pediatrics and a lead author of the study. Chickenpox, which is caused by varicella-zoster virus, affects 3.5 million people in the United States annually. Although complications are rare, the researchers report, more than 4,500 otherwise normal children are hospitalized each year because of the infection.
The recent study involved 815 healthy children from two to 12 years old, each of whom developed a characteristic chickenpox rash within 24 hours prior to enrolling in the study. Half of the children received acyclovir and half received a placebo. The children were all seen daily for the first four days, on the sixth day, and again 28 days after the rash first appeared.
The study was supported by a grant from the Burroughs Wellcome Company, which manufactures acyclovir under the trade name Zovirax. Participating institutions, in addition to Stanford, included St. Louis University, University of Alabama at Birmingham, University of Colorado, University of Connecticut Health Center, University of Mississippi, Columbia University, Baylor College of Medicine, University of Virginia Health Sciences Center, and University of Minnesota.
More than 95 percent of the children who received acyclovir stopped developing a rash and started healing by the third or fourth day of treatment. Of the children not receiving the drug, 20 percent were still developing lesions and had not begun healing by the sixth day of treatment. In addition, children who received placebo generally developed more lesions, suffered more itching, and had more residual lesions after 28 days than children treated with acyclovir.
Adverse side effects of the acyclovir were minimal, but the most common complaints were gastrointestinal. Overall, however, the benefits of acyclovir were clear. The researchers concluded that the study suggested "an important clinical benefit of early acyclovir treatment for healthy children with chickenpox."
But not every child will need treatment. "Physicians will have to begin now to decide which patients really should be treated," said Arvin. "The infectious disease committee of the Academy of Pediatrics is likely to review this information and make recommendations about what would be the best indications for treatment."
Although the study did not address the economic consequences of chickenpox, the researchers noted that "antiviral therapy that reduces the severity or duration of infectivity is likely to allow the parent or other care-giver to return to work sooner. For some families, the cost of a five-day course of acyclovir, which is approximately $32.00 for a [44- pound] child, may be balanced by such indications."
Children may be happy to hear that researchers believe the treatment could result in fewer visits to the doctor. The down side for kids? The treatment may also lead to fewer days missed from school. -lbj-
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