A symptomatic neonate with confirmed congenital cytomegalovirus infection has microcephaly, periventricular calcifications and chorioretinitis. Urine PCR is positive. What is the recommended antiviral regimen?

• A Oral valganciclovir for 6 weeks
• B Oral valganciclovir for 6 months ✓
• C Intravenous ganciclovir for 6 months
• D Oral acyclovir for 6 months

Explanation

Symptomatic congenital CMV disease with central nervous system involvement warrants oral valganciclovir for 6 months, based on evidence of improved hearing and neurodevelopmental outcomes compared with a 6-week course. Six weeks of valganciclovir is reserved for symptomatic disease without CNS involvement. Acyclovir has negligible activity against CMV, and prolonged intravenous ganciclovir is impractical and carries line-related complications. Neutropenia requires monitoring during therapy.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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