TABLE 88-3.
Antiviral Agents and Indications for Use
| Virus | Durug of Choice/Dose | Alternate Agents |
|---|---|---|
| Adenovirus | There is no currently approved therapy for the treatment of adenoviral infections. | Both ribavirin and cidofovir have in vitro activity against adenovirus. |
| Small case series in immunocompromised children have suggested potential efficacy with intravenous ribavirin (25 mg/kg loading dose then 10 mg/kg/daily— available on compassionate use basis) or cidofovir (5 mg/kg once weekly)115'116 | ||
| Enterovirus | There is no currently approved therapy for the treatment of enteroviral infections | Pleconoril (VP63843) (5 mg/kg po or per nanogram tid, maximum dose 400 mg) has not yet been approved by the FDA but is available on a compassionate-use basis for neonatal enteroviral sepsis, myocarditis, chronic meningocephalitis, severe infections in patients with bone marrow transplants, and vaccine-associated paralytic polio |
| Hantavirus | Intravenous ribavirin has shown benefit in hantavirus renal syndrome,117 but not in hantavirus pulmonary syndrome112 | |
| Herpesvirus | ||
| CMV | Ganciclovir (5 mg/kg q 12 hr × 2-3 wk, then 5 mg/kg q 24 hr) is primary therapy for CMV disease; IVIG (500 mg/kg qod × 2 wk then once weekly) or CMV-IG (150 mg/kg, same schedule) should be given concurrently for CMV pneumonia in immunocompromised patients | Foscarnet (90 mg/kg q 12 hr × 2-3 wk, then 90 mg/kg q 24 hr), cidofovir (5 mg/kg/wk—high risk of renal toxicity, use with probenecid and saline hydration); increased efficacy of cidofovir suggested in allogeneic stem cell transplant recipients with CMV pneumonia in one small study113 |
| HSV | Acyclovir (20 mg/kg/dose IV q 8 hr) for encephalitis in neonates and children younger than 12 yr and for neonates with disseminated disease | No specific dosing recommendations are available for HSV-associated hepatitis and pneumonitis; at least 10 mg/kg/dose should be considered outside of the neonatal period |
| HHV-6 | Foscarnet and ganciclovir have in vitro activity; case reports and series show variable clinical response with one or both drugs in combination | |
| VZV | Acyclovir (10-12 mg/kg/dose q 8 hr) High dose (20 mg/kg/dose) should be used for VZV encephalitis or for disease in immunocompromised children | |
| Influenza A/B | Oseltamivir (2 mg/kg bid × 5 days—max, 75 mg bid) | Rimantadine or amantidine (5 mg/kg/day div bid—max, 75 mg bid)—influenza A only |
| JC Virus | No effective therapy | In HIV infection, treatment with combination antiretroviral therapy may improve survival; potential role for cidofovir114 |
| Parainfluenza | Treatment for parainfluenza pneumonia should include coverage for copathogens; ribavirin and IVIG remain controversial, with a recent review showing no benefit34 | |
| RSV | Aerosolized ribavirin (6 g reconstituted in 100 ml tid × 5 days) has been used with modest efficacy in patients with severe RSV pneumonia and in immuno- compromised patients—not recommended for uncomplicated disease | Combination therapy with ribavirin and palivizumab (RSV monoclonal antibody) or ribavirin and RSV-IG may improve outcome of RSV pneumonia in immunocompromised patients—under investigation |
CMV, cytomegalovirus; div, divided; HHV-6, human herpesvirus 6; HIV, human immunodeficiency virus; HSV, herpes simplex virus; IG, immune-globulin; IV, intravenous; IVIG, intravenous immunoglobulin; JCV, JC virus; max, maximum; RSV, respiratory syncytial virus.