Table 2.
Antiviral medications for CMV prevention and treatment in pediatric SOT.
| Medication | Prophylaxis | Treatment | Considerations |
|---|---|---|---|
| Ganciclovir (I.V.) | 5 mg/kg I.V. once daily | 5 mg/kg I.V. every 12 h | Dose adjustments needed for CrCl <70 ml/min/1.73 m2 |
| Valganciclovir (oral) | Dose (mg): 7 x BSAa x CrClb once daily Alternativec: 14–17 mg/kg once daily |
Dose (mg): 7 x BSA x CrCl twice daily | Max single dose: 900 mg Dose adjustments needed for CrCl < 60 ml/min/1.73 m2 |
| Valacyclovir (oral) | Adult: 2,000 mg 4 times per day Pediatric: dosing has not been established |
Not recommended | Dose adjustments needed for CrCl < 50 ml/min/1.73 m2 |
| Maribavir (oral) | Not recommended | Patients ≥12 years AND ≥35 kg: 400 mg twice dailyd | May increase concentrations of common immunosuppression (calcineurin and mTOR inhibitors) |
| Foscarnet (I.V.) | Not recommended | 60 mg/kg I.V. every 8 h OR 90 mg/kg I.V every 12 h | Second- or third-line option for resistant CMV Nephrotoxic Dose adjustments needed for kidney impairment |
| Cidofovir (I.V.) | Not recommended | 5 mg/kg once weekly x 2, then every 2 weeks thereafter in combination with Probenecid | Third-line option for resistant CMV Nephrotoxic Dose adjustments needed for kidney impairment |
a
Body surface area calculated using Mosteller body surface area equation.
b
Creatinine clearance calculation based on modified Schwarz formula. Max CrcL of 150 ml/min/1.73 m2.
c
Off-label dosing.
d
For treatment of refractory CMV.