Famciclovir Versus Acyclovir in The Management of Herpes Zoster: Effects on Rash Healing, Pain, And Post-Herpetic Neuralgia

Background: Herpes zoster, commonly known as shingles, results from the reactivation of latent varicella-zoster virus (VZV) residing in dorsal root ganglia following primary infection. Early initiation of antiviral therapy has been shown to reduce viral replication, accelerate lesion healing, decrease acute pain severity, and lower the risk of PHN. Acyclovir and famciclovir are commonly used antiviral agents; however, differences in pharmacokinetics, dosing convenience, and clinical outcomes necessitate comparative evaluation. Objective: To compare the efficacy and tolerability of Famciclovir and Acyclovir in treating Herpes Zoster. Methods: This randomized, open-label, prospective, parallel-group study was conducted in 60 patients with clinically diagnosed herpes zoster. Participants were randomly allocated into two equal groups. One group received oral famciclovir 500 mg three times daily, while the other group received oral acyclovir 800 mg five times daily, both for a duration of seven days. Patients were followed up regularly to assess time to complete rash healing, reduction in pain intensity using standardized pain scales, development of post-herpetic neuralgia, and occurrence of adverse drug reactions. Data were analyzed using appropriate statistical tests, with a p-value <0.05 considered statistically significant. Results: Patients treated with famciclovir demonstrated significantly faster rash healing compared with those receiving acyclovir (7.2 ± 1.8 days vs 9.1 ± 2.2 days; p = 0.003). Pain reduction was also more pronounced in the famciclovir group, with a 78% decrease in pain scores compared to a 65% reduction in the acyclovir group (p = 0.01). Furthermore, the incidence of post-herpetic neuralgia was significantly lower among patients treated with famciclovir (10%) compared with those treated with acyclovir (26%; p = 0.04).  Conclusion: Famciclovir demonstrated superior efficacy compared with acyclovir in the treatment of herpes zoster, with faster lesion healing, greater pain relief, and a lower incidence of post-herpetic neuralgia. Its favorable tolerability and convenient dosing make famciclovir a preferred antiviral option for the management of herpes zoster