Complications and Antiviral Strategies in Herpes Zoster: A Retrospective Evaluation of 50 Patients Treated in a Secondary Care Setting

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Purpose: To evaluate clinical characteristics, antiviral treatment patterns, complication rates, and the role of vitamin B12 supplementation among patients with herpes zoster (HZ) managed in a secondary care setting. Patients and Methods: Fifty adults with clinically diagnosed HZ (July 2019–October 2020) were included. Demographics, comorbidities, dermatomal involvement, laboratory findings, antiviral therapy (acyclovir, valacyclovir, brivudine), vitamin B12 use, and complications were recorded. Patients were stratified by age (< 65 vs ≥ 65 years). Categorical variables were compared using chi-square or Fisher’s exact test, and continuous variables with t -test or Mann–Whitney U -test. Ninety-five percent confidence intervals (CIs) were calculated. Results: The mean age was 63 ± 16 years, and 58% of patients were female. Diabetes and hypertension were the most common comorbidities. All patients received antiviral therapy within 72 hours of symptom onset. Postherpetic neuralgia (PHN) occurred in 8% of patients, and 2% developed secondary bacterial infection. Complication rates were 0% with acyclovir, 5.3% with valacyclovir, and 21.1% with brivudine (p = 0.112). No statistically significant difference in complication rates was observed between patients who received vitamin B12 and those who did not (p = 1.00). Complications occurred more frequently in patients aged ≥ 65 years compared with those < 65 years (16% vs 4%; p = 0.35). ALT levels were significantly lower in patients aged ≥ 65 years (p = 0.015). Conclusion: Early antiviral therapy was associated with a low incidence of PHN. Although brivudine was associated with a higher complication rate, causality cannot be established. The role of vitamin B12 remains uncertain. Larger prospective studies are warranted. Plain Language Summary: Shingles, also known as herpes zoster, is a painful rash caused by the reactivation of the chickenpox virus later in life. It most often affects older adults and people with chronic health conditions. The main complication is long-lasting nerve pain, called postherpetic neuralgia (PHN), which can greatly affect daily life. In this study, we reviewed the medical records of 50 patients treated for shingles at a secondary care hospital. All patients started antiviral therapy within three days of rash onset, and most also received pain medications. Vitamin B12 was prescribed for some patients, reflecting common practice in our country. We found that only 8% of patients developed PHN and 2% had a bacterial skin infection. Patients who received brivudine appeared to have more complications compared with those treated with acyclovir or valacyclovir, but the difference was not statistically significant. Vitamin B12 supplementation did not appear to change outcomes. These findings suggest that starting antiviral treatment early may help lower the risk of long-term nerve pain after shingles. However, since this was a small, single-center study, the results should be interpreted with caution. Larger studies are needed to confirm these findings and to clarify whether additional treatments, such as vitamin B12, play a role in preventing complications. Keywords: herpes zoster, antiviral therapy, postherpetic neuralgia, brivudine, valacyclovir, vitamin B12, complications

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