In 1984 we hailed acyclovir (ACV; Zovirax - Wellcome) as an advance in the treatment of herpes simplex and varicella zoster infections.1 Most trials showing its value in zoster involved intravenous infusion in hospital, yet most patients would not otherwise need admission. Oral ACV is now vigorously promoted “to quench the fire of shingles” in the community. At least 20% of adults have zoster at some time, and most recover spontaneously. How does oral ACV compare with alternative treatments for zoster, and when is it worth using?
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