Approach to the treatment of life-threatening congenital cytomegalovirus infection

This algorithm is intended for use in conjunction with additional UpToDate content on congenital CMV infection. Refer to UpToDate topic on the management of congenital CMV infection for additional details of our approach to treatment and the overall efficacy of these treatments.

CMV: cytomegalovirus; SCID: severe combined immunodeficiency; IV: intravenous; CBC: complete blood count; LFTs: liver function tests; CMV DNAemia: measurement of CMV viremia by quantitative polymerase chain reaction (PCR); ANC: absolute neutrophil count; G-CSF: granulocyte colony stimulating factor.
* Dose must be adjusted in infants with renal impairment. Dosing recommendations for valganciclovir are for commercially available oral suspension only.
¶ Significant toxicity includes any of the following:

Persistent neutropenia (ANC <500/microL).
Persistent thrombocytopenia (platelets <50,000 cells/microL) requiring transfusion. Worsening thrombocytopenia during antiviral therapy while CMV DNAemia levels are declining suggests possible drug-induced thrombocytopenia.
Persistent hepatitis (transaminases >250 int. units/L) without other identified causes.

Δ Alternatively, patients with ganciclovir-induced neutropenia may be treated with G-CSF.
◊ IV ganciclovir therapy should not exceed 6 weeks, due to risks of toxicity.

Graphic 100750 Version 4.0

خرید پکیج

Approach to the treatment of life-threatening congenital cytomegalovirus infection