Pre-emptive treatment of Cytomegalovirus

Valganciclovir is equally efficacious in preventing CMV disease when used as prophylaxis or as pre-emptive treatment (Level 2 evidence but not designed for this outcome) Pre-emptive treatment of CMV infection results in significantly less leukopenia than prophylaxis, however, there is no difference in other adverse events. Pre-emptive treatment with 1⁄2 dose ganciclovir and 1⁄2 dose foscarnet results in increased drug toxicity compared with full dose ganciclovir alone. The cost of both prophylaxis and pre-emptive treatment is substantial and depends on the costing of the diagnostic test and medications in individual units. Pre-emptive treatment depends on an accurate diagnostic test. Both CMV polymerase chain reaction (PCR) testing and pp65 antigenaemia testing appear efficacious in the detection of CMV infection when used in trials of pre-emptive therapy. All studies have used CMV testing at weekly or fortnightly intervals in patients treated with pre-emptive therapy.