Table 5 : Recent recommendations in the treatment of Ramsay Hunt syndrome.

Study/year No. of
  Cortico- steroid
VZV Vaccine Initiation of
Comments / strong
points of study

Coulson 2011 101 YES From 1998, famciclovir 250mg x 3, 21d   1mg/kg/d, 14d,
decreased by 10mg/d
until 0
NC Early:< 5d
Late: > 5d
Statistically significantly better in combination treatment of early ACY+late COR

Uri 2003 31 YES ACY 15mg/kg/d for   7d   100mg x 3 for   7d NC Early 1-3d
Late 4-7d
Recommends IV ACY over oral administration

Kinishi 2001 91 YES ACY 4000 mg/d for   7d   500à100 mg/d decreased
over 7d
NC < 7d Assess ACY+COR on facial nerve recovery compared to COR alone

Hato 2000 52 NC NC   NC YES NC Reviews prognostic factors for children with RHS. None of the 52 had VZV vaccine; the incidence of RHS in later years drops

Murakami 1997 80 YES ACY either 250mg x 3 IV or 800mg x 5 orally for 7d   1mg/kg/d for 5d, decreased
10 mg/d until 0, over 10d
NC Early 1-3d
Late >7d
75% recovered in 1-3d group
30% recovered in >7d group
Argues that onset of treatment is essential

De RU 2011 NA YES NA   NA NC NC Meta-analysis of reviews 1985-2010 – strongly recommend combination therapy

2008 (oct)
NA No evidence NA   NA Maybe < 3d Cochrane Review; finds no quality RCT to support the use of antiviral compared to the use of COR alone

2008 (June)
NA No evidence NA   NA Maybe < 3d Cochrane Review; finds no RCT at all to address use of COR to support antivirals

ACY: Acyclovir, COR: Corticosteroids, VZV: Varicella zoster virus, NC: Not commented, NA: Not applicable, RCT: randomized controlled trials, IV: Intravenously, d: days

Rasmussen et al.Virology Discovery  2014 2:1DOI : 10.7243/2052-6202-2-1