Secondary prophylaxis in children 1 month and older

Choice of antiviral therapy for secondary prophylaxis after an episode of active CMV disease is based on factors including CMV resistance, response to treatment and drug contraindications.

If secondary prophylaxis is indicated (see c_abg16-c21-s3.html#abg16-c21-s3__tabg16-c21-tbl2), suggested regimens are provided below. Seek expert advice about dosing in children. Use:

1 valganciclovir   cytomegalovirus disease, secondary prophylaxis (child) valganciclovir

child 1 to 12 months: 16 mg/kg orally, once daily

child older than 12 months: dose (mg) = 7 x body surface area (m2) x estimated glomerular filtration rate (mL/minute/1.73 m2) (up to 900 mg) orally, once daily1

OR

2 ganciclovir 5 mg/kg intravenously, daily. Switch to oral valganciclovir (see dosage above) when possible2 cytomegalovirus disease, secondary prophylaxis (child) ganciclovir

OR

3 foscarnet 90 to 120 mg/kg intravenously, daily cytomegalovirus disease, secondary prophylaxis (child) foscarnet

OR

4 cidofovir 5 mg/kg intravenously, every 2 weeks, administer with probenecid (refer to local protocols or guidelines for dosage of probenecid)3. cytomegalovirus disease, secondary prophylaxis (child) cidofovir

For information about duration of therapy, see c_abg16-c21-s3.html#abg16-c21-s3__tabg16-c21-tbl2.

1 Use the online calculator to determine body surface area. Use the modified Schwartz formula to calculate estimated glomerular filtration rate (GFR) in children older than 1 year.Return
2 Ganciclovir regimens in local guidelines vary; some centres use a higher dose and reduce the frequency of administration (eg 6 mg/kg intravenously 5 days a week)—seek expert advice or refer to local protocols and guidelines.Return
3 Cidofovir does not penetrate the CNS and should not be used to treat CMV encephalitis.Return