Cytomegaly: Drug Therapy

Therapeutic targets

  • Improvement of the symptomatology
  • Avoidance of complications

Therapy recommendations

  • Symptomatic therapy (analgesics, antipyretics, if necessary).
  • Virostasis (virostatics/drugs that inhibit viral replication; indication: for life-threatening disease, immunosuppression, and complications, e.g., pneumonia (pneumonia), retinitis (retinitis), encephalitis (encephalitis), congenitally (congenitally) infected neonates and premature infants
    • Immunocompetent patients usually do not require antiviral therapy.
    • In transplanted patients, asymptomatic viremia is already treated (preemptive therapy/preempting the disease).
  • Immunocompetent asymptomatic ill patients are not treated with antivirals.
  • Pregnancy:
    • The following antivirals are not recommended for pregnant or breastfeeding women: Cidofovir, fomivirsen, foscarnet, ganciclovir, valganciclovir.
    • After seroconversion in the first trimester (third trimester) can be considered – according to individual risk constellation in individual cases – the administration of hyperimmunoglobulin (HIG) or antivirals; however, the results on this are not very encouraging!
  • Outside pregnancy
    • For example, in CMV pneumonia: nucleoside analogues ganciclovir, valganciclovir (orally available prodrug of ganciclovir); cidofovir; pyrophosphate analogue foscarnet.
    • In severe CMV syndrome or invasive CMV disease: ganciclovir intravenously (5 mg/kg every 12 h)Duration of therapy: at least 20 weeks, longer if necessary; even in the case of leukopenia (lack of leukocytes (white blood cells) in the blood), do not immediately reduce the dose, because of the risk of developing resistance. Note: Verify inhibition of viral replication with one- to two-weekly PCR checks.
    • Immunosuppression may need to be reduced in immunocompromised patients.
  • Prophylaxis of cytomegalovirus (CMV) reactivation and disease in adult CMV-seropositive recipients [R+] of allogeneic hematopoietic stem cell transplantation (HSCT)/the same applies to immunosuppressed organ transplant recipients: Letermovir
  • See also under “Other therapy.”

Note: If therapy is not successful, CMV resistance testing is required.

Virostatics Virostatics are drugs that stop the reproduction of viruses. They inhibit an enzyme in the virus that replicates the genetic information. However, these drugs do not reach dormant viruses in the nerve ganglia (nerve nodules), so recurrences (reoccurrence) are possible.