Ganciclovir, a synthetic acyclic nucleotide analog of guanine, is phosphorylated to a triphosphate within the cell and acts as an inhibitor of viral DNA synthesis. Preliminary data have shown ganciclovir effective in the treatment of symptomatic congenital CMV infection. A phase II study with ganciclovir showed hearing improvement or stabilization in five of 30 infants with symptomatic congenital CMV infection at six months or later. During the treatment period, quantitative excretion of CMV in the urine decreased. However, after cessation of therapy, viruria returned to near pre treatment levels. A phase III randomized trial suggests that ganciclovir may benefit infants with severe congenital CMV infection. Central nervous system damage that has already occurred will not be reversed, but ongoing viral replication causing postnatal damage is controlled campared to untreated CMV-infected controls. The value of ganciclovir for the prevention or treatment of hearing loss in asymptomatic children has not been determined. Side effects of ganciclovir include bone narrow suppression and potential gonadal toxicity. Presently there is insufficient data to justify the routine use of ganciclovir in the treatment of congenital CMV infection.
Children with congenital CMV infection are at risk for hearing loss, mental retardation, psychomotor delay, cerebral palsy, and impaired vision. This is especially so for the hearing loss, for as many as 80% of cases are of late-onset or progressive. As such, children with congenital CMV infection should have long-term audiologic, neurodevelopmental, and ophthalmic follow-up for early identification of these problems.
Women of childbearing age should practice meticulous personal hygiene, such as avoidance of contact with urine or saliva of others and proper hand-washing after such contact. Nurses who practice good handwashing do not have increased rates of CMV acquistition, but daycare workers often do, suggesting that barrier precautions are effective in interrupting transmission. Several candidate vaccines are under development. These vaccines are urgently needed and ultimately may be an important preventive measure.