Do herpes zoster patients receive antivirals? A Dutch national survey in general practice

Background. The main complications of herpes zoster (HZ) are postherpetic neuralgia and, in case of HZ ophthalmicus, eye disorders. Antiviral treatment may modify the course of disease and reduce the risk of complications. Objective. To assess which doctors' and patients' characteristics were related to prescription of antiviral therapy for HZ. Methods. Ninety general practices (358 008 patients) in The Netherlands registered all patient contacts in a database for one year as part of the Second Dutch National Survey of General Practice. The present study used ICPC code S70 to search that database for patients with a new diagnosis of HZ. The full-text medical records of the selected patients were then reviewed and the potential determinants for the prescription of antiviral drugs (including characteristics of patients, GPs, and practices) analysed using multilevel logistic regression modelling. Results. Of the 1129 patients diagnosed with HZ (incidence 3.2/1000 patients/year), 22.5% received antiviral drugs. Independent determinants for prescription of antiviral therapy were age [45-54 years: Adjusted odds ratio (OR) 2.9 (95% CI 1.6-5.0); 55-64 years: OR 4.2 (95% CI 2.4-7.6); 65-74 years: OR 5.1 (95% CI 2.7-9.6); ≥75 years: OR 8.1 (95% CI 4.4-15.1)], ophthalmic localisation of the shingles (OR 3.2, 95% CI 1.6-6.7), and the presence of asthma/COPD (OR 1.6, 95% CI 1.0-2.6). GPs who reported to strongly adhere to professional guidelines prescribe more frequently antiviral drugs (OR 1.9, 95% CI 1.2-3.1). Conclusions. A minority of HZ patients were prescribed antiviral treatment. Increasing age, ophthalmic localisation, presence of asthma/COPD, and adherence to professional guidelines were factors favouring prescription. More information on the determinants of GPs' treatment decisions is necessary for successful implementation of HZ guidelines.