title: Prescription of antiviral therapy after herpes zoster in general practice: who receives therapy?
abstract: BACKGROUND
  Antivirals can accelerate rash healing during an acute zoster episode and can limit the severity and duration of pain. Their use within 7 days of rash onset is recommended among specific patient groups.
  
  
  OBJECTIVE
  To describe antiviral prescription  patterns and patient characteristics associated with antiviral receipt after zoster diagnosis.
  
  
  METHODS
  Descriptive study and risk factor analysis using electronic healthcare records from UK general practice.
  
  
  METHODS
  Incident adult zoster cases  occurring between 2000 and 2011 were identified in the General Practice Research Database. Therapy records were searched for antiviral prescriptions of aciclovir, famciclovir, or valaciclovir within 7 days of zoster diagnosis. The proportion of incident zoster cases receiving antivirals was  calculated and multivariable logistic regression used to assess associations between patient characteristics and antiviral use.
  
  
  RESULTS
  Of 142 216 incident zoster cases 58.1% received an antiviral prescription. The majority (69.0%) were aciclovir. The proportion receiving  antiviral prescriptions increased with age up to 65 years, then declined to 56.8% among patients aged ≥85 years. Being female and of higher socioeconomic status were associated with higher antiviral receipt. Antivirals were more commonly prescribed to immunosuppressed patients with herpes  zoster (odds ratio 1.27; 95% CI = 1.22 to 1.33), however they were not given routinely to this patient group.
  
  
  CONCLUSIONS
  Antiviral therapies for zoster are under-prescribed in UK general practice even among groups, such as immunosuppressed and older individuals, for whom  guidelines recommend treatment. Patients may present too late to receive treatment or physicians may decide that antivirals are not essential treatment. Consideration could be given to reviewing the guidelines.
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK. Harriet.forbes@lshtm.ac.uk
authors.forename: Harriet J
authors.initials: HJ
authors.lastname: Forbes
authors.forename: Sara L
authors.initials: SL
authors.lastname: Thomas
authors.forename: Liam
authors.initials: L
authors.lastname: Smeeth
authors.forename: Sinéad M
authors.initials: SM
authors.lastname: Langan
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications; D004739:England; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006562:Herpes Zoster / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007108:Immune Tolerance / Q000502:physiology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012111:Residence Characteristics; D017678:Sex Distribution; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents