Dawaa Reference

infectious

Varicella (chickenpox)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

NICE CKS Chickenpox 2021 · MSF Essential Drugs 2024 - paracetamol (oral) · Egyptian National Drug Formulary - Antimicrobial 2023 (acyclovir monograph)

Verified against3 documents
  • 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)

Verified date2026-08

Presentation reference

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

SourceStatPearls "Varicella-Zoster Virus (Chickenpox)" - disease-level clinical article

Presentation findings are traced to the source above.

1

PARACETAMOL

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

1 g 3 or 4 times daily (max. 4 g daily)

Paediatric dose

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).)

Dose by weight
3kg45 mg/dose
4kg60 mg/dose
5kg75 mg/dose
6kg90 mg/dose
7kg105 mg/dose
8kg120 mg/dose
9kg135 mg/dose
10kg150 mg/dose
11kg165 mg/dose
12kg180 mg/dose
13kg195 mg/dose
14kg210 mg/dose
15kg225 mg/dose
16kg240 mg/dose
17kg255 mg/dose
18kg270 mg/dose
19kg285 mg/dose
20kg300 mg/dose
21kg315 mg/dose
22kg330 mg/dose
23kg345 mg/dose
24kg360 mg/dose
25kg375 mg/dose
26kg390 mg/dose
27kg405 mg/dose
28kg420 mg/dose
29kg435 mg/dose
30kg450 mg/dose
31kg465 mg/dose
32kg480 mg/dose
33kg495 mg/dose
34kg500 mg/dose (capped)
35kg500 mg/dose (capped)
36kg500 mg/dose (capped)
37kg500 mg/dose (capped)
38kg500 mg/dose (capped)
39kg500 mg/dose (capped)
40kg500 mg/dose (capped)
41kg500 mg/dose (capped)
42kg500 mg/dose (capped)
43kg500 mg/dose (capped)
44kg500 mg/dose (capped)
45kg500 mg/dose (capped)
46kg500 mg/dose (capped)
47kg500 mg/dose (capped)
48kg500 mg/dose (capped)
49kg500 mg/dose (capped)
50kg500 mg/dose (capped)
Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEBRIMOL 500 MG 20 TAB.PHARCO3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.MEMPHIS8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.MUP13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.EIPICO24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.UTOPIA42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.MISR38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETSJULPHAR32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETSAUG PHARMA50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidPHAROPHARMA5.00 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose 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.

Cautions
  • 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

Strength800 mg

Formoral.solid

Adult dose and duration

800 mg orally 5 times daily (every 4 hours while awake) - ≥5 to 7 days and until all lesions have crusted

Paediatric dose

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)

Dose by weight
3kg60 mg/dose
4kg80 mg/dose
5kg100 mg/dose
6kg120 mg/dose
7kg140 mg/dose
8kg160 mg/dose
9kg180 mg/dose
10kg200 mg/dose
11kg220 mg/dose
12kg240 mg/dose
13kg260 mg/dose
14kg280 mg/dose
15kg300 mg/dose
16kg320 mg/dose
17kg340 mg/dose
18kg360 mg/dose
19kg380 mg/dose
20kg400 mg/dose
21kg420 mg/dose
22kg440 mg/dose
23kg460 mg/dose
24kg480 mg/dose
25kg500 mg/dose
26kg520 mg/dose
27kg540 mg/dose
28kg560 mg/dose
29kg580 mg/dose
30kg600 mg/dose
31kg620 mg/dose
32kg640 mg/dose
33kg660 mg/dose
34kg680 mg/dose
35kg700 mg/dose
36kg720 mg/dose
37kg740 mg/dose
38kg760 mg/dose
39kg780 mg/dose
40kg800 mg/dose
41kg800 mg/dose (capped)
42kg800 mg/dose (capped)
43kg800 mg/dose (capped)
44kg800 mg/dose (capped)
45kg800 mg/dose (capped)
46kg800 mg/dose (capped)
47kg800 mg/dose (capped)
48kg800 mg/dose (capped)
49kg800 mg/dose (capped)
50kg800 mg/dose (capped)
Dose 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.

Cautions
  • 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
Egyptian brands
Egyptian brandManufacturerIndicative price
VIRUSTAT 800MG 35 TAB.PHAROPHARMA266.00 EGP (7.60/unit)
ACIVIRAX 800MG 20 TABS.MASH PREMIERE154.00 EGP (7.70/unit)
LOVIR 800 MG 35 ORAL DISP. TABS.SUN PHARMA EGYPT LIMITED300.00 EGP
BORGAVIRAX 200MG/5ML SUSP. 125 ML? strength differs? different route - not oral solidBORG61.00 EGP
VIRUSTAT 200MG/5ML SUSP. 120 ML? strength differs? different route - not oral solidPHAROPHARMA61.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.