Table 1.

Standard therapies against CMV.

Drugs	Mechanism	Dosing Regimens	Main Adverse Events and Considerations
Ganciclovir	Inhibits DNA polymerase (encoded by UL54 gene, Needs to be phosphorylated by viral phosphotransferase (encoded by UL97 gene)	Induction: 5 mg/kg IV every 12 h for at least 7–14 days Maintenance: 5 mg/kg IV once daily until test is negative Note: Minimum total induction and maintenance treatment is 2 weeks when 14 days of induction is used, and 3 weeks when a 7-day induction course is used.	Myelosuppression, Nephrotoxicity
Valganciclovir	Inhibits DNA polymerase, orally bioavailable formulation prodrug of ganciclovir	(Persons ≥40 kg with good oral intake) Induction: 900 mg PO twice daily for at least 14 days Maintenance: 900 mg PO once daily for 1–2 weeks until test is negative Note: Minimum treatment course is 14 days regardless of drug used	Myelosuppression, Nephrotoxicity
Foscarnet	Inhibits DNA polymerase UL54 directly by this pyrophosphate analogue	Induction: 60 mg/kg IV every 8 h or 90 mg/kg every 12 h for 2–3 weeks Maintenance: 90 to 120 mg/kg once daily	Nephrotoxicity, Electrolyte imbalance, Myelosuppression
Cidofovir	Nucleotide analogue that inhibits DNA polymerase UL54	Induction: 5 mg/kg IV every weekly for 2 weeks Maintenance: 5 mg/kg IV every 2 weeks	Nephrotoxicity, Myelosuppression; Hydration and probenecid required to reduce nephrotoxicity
Leflunomide	Inhibits virion assembly, frequently used as add-on therapy	Loading dose: 100 mg orally once daily for 3 days only for patients at low risk for hepatotoxicity or myelosuppression Maintenance dose: 20 mg orally once daily; may reduce dose to 10 mg orally once daily if higher dose not tolerated	Liver cytolysis, Myelosuppression
CMV Ig/Polyclonal Ig	Increase CMV antibody levels	Varies among different studies and disease status	Infusion reactions

Abbreviation: CMV, cytomegalovirus; Ig, immunoglobulin.