Table 13 Target therapeutic agents by causative microorganism
Causative microorganism | Source of infection | Susceptibility result | Options | Alternatives | Remarks | |
|---|---|---|---|---|---|---|
Gram-positive cocci in clusters [GPC in clusters] | ||||||
Staphylococcus aureus Staphylococcus aureus(continued) | Catheter-related bloodstream infections, vertebral osteomyelitis / septic arthritis / iliopsoas abscess, native valve endocarditis (without intracranial dissemination), pneumonia | MSSA(PCG: S & CEZ: S) * When determining “PCG: S”, non-producer of penicillinase must be confirmed. | PCG 4,000,000 units, every 4–6 h [111,112,113] or ABPC 2 g, every 4–6 h [5] (endocarditis: every 4 h; other: every 4–6 h) | CEZ | ||
MSSA(PCG: R & CEZ: S) | Concomitant GM is not recommended [11]. | |||||
MRSA(CEZ: R & VCM: S) | VCM initial dose 25–30 mg/kg, subsequent doses 15–20 mg/kg, every 12 h [5, 11, 18, 87, 114, 115] | |||||
Native valve endocarditis(with intracranial dissemination), post-operative meningitis (including cerebrospinal fluid shunt infection) | MSSA(PCG: S & CEZ: S) *When determining “PCG: S”, non-producer of penicillinase must be confirmed. | PCG 4,000,000 units, every 4–6 h [111,112,113] or ABPC 2 g, every 4–6 h [5] (endocarditis: every 4 h; other: every 4–6 h) | Avoid CEZ | |||
MSSA(CEZ: S) | CTRX 2 g, every 12 h or CFPM 2 g, every 8 h or MEPM 2 g, every 8 h [11, 89] | Avoid CEZ | CTX was listed in ESC 2015 [114]. | |||
MRSA(CEZ: R & VCM: S) | VCM initial dose 25–30 mg/kg,subsequent doses 15–20 mg/kg, every 12 h [5, 11, 18, 87, 114, 115] | VCM target trough levels: 15–20 μg/mL [11, 18, 115]. VCM + RFP, etc. for BSAC 2012 [116] | ||||
Prosthetic valve endocarditis | GM: S & RFP: S | Each regimen of native valve endocarditis (mentioned above) + GM 2–3 mg/kg, every 24 h ± oral RFP 600 mg once a day (combination of three drugs) [11, 87, 114, 115] | Concomitant use of GM for 2 weeks. Target GM levels: 3–5 μg/mL at peak, less than 1 μg/mL at trough [11, 18]. See section on “Coagulase Negative Staphylococcus (CNS)” (next section) for RFP addition | |||
GM: R, AMK or LVFX: S | Substitute for GM in previous section: AMK or LVFX | |||||
Toxic shock syndrome | CLDM: S | Each above-mentioned regimen+CLDM 600 mg, every 8 h [117] | ||||
CLDM: R & LZD: S | Each above-mentioned regimen+CLDM 600 mg, every 8 h or each above-mentioned regimen+LZD 600 mg, every 12 h [117] | CLDM is for toxin production suppression purposes (suppression can also be done even when R) [118] | ||||
Coagulase-negativeStaphylococcus(CNS) | Catheter-related bloodstream infections, prosthetic valve endocarditis, prosthetic joint infection | ・Susceptibility-based selection is similar with that for Staphylococcus aureus. → see section on “Staphylococcus aureus” (above). ・RFP addition can be considered when conducting hardware retention strategy for prosthetic valve endocarditis or prosthetic joint infection. → Never use RFP alone due to rapid development of resistance. There is expert opinion on avoiding its use when there is a large quantity of bacteria. Susceptibility test results serve as a reference [5, 11, 87, 114]. | ||||
Gram-positive cocci in chains <GPC in chains> | ||||||
Streptococcus pneumoniae*Note that PCG susceptibility criteria differ for meningitis and non-meningitis | Other than meningitis (e.g., pneumonia) | PCG: S(MIC ≤2 μg/mL) | PCG 2,000,000 units, every 4 h or ABPC 2 g, every 6–8 h [5] (PCG 4,000,000 units, every 4 h or ABPC 2 g, every 4 h for endocarditis/invasive infection) | CTRX | ||
PCG: I or R(MIC ≥4 μg/mL) | CTRX 2 g, every 24 h [5] | VCM or LVFX (if S) | ||||
Meningitis | PCG: S(MIC ≤0.06 μg/mL) | PCG 4,000,000 units, every 4 h [5, 12] or ABPC 2 g, every 4 h [5, 119] | CTRX | |||
PCG: R(MIC ≥0.12 μg/mL)& CTRX: S(MIC ≤0.5 μg/mL) | CFPM [89] | |||||
PCG: R(MIC ≥0.12 μg/mL)& CTRX: I or R(MIC ≥1.0 μg/mL) | VCM initial dose 25–30 mg/kg,subsequent doses 15–20 mg/kg, every 12 h + CTRX 2 g, every 12 h [5, 12, 18] (considering CTRX MIC>2 μg/mL& RFP: S, and RFP addition) [5, 119] | |||||
Group A, B, C, F, G Streptococcus β-hemolytic cocci in chains | Bacteremia, soft tissue infection | PCG: S | PCG 2–4,000,000 units, every 4 h [5] or ABPC 2 g, every 4–6 h | CEZ or CTRX | CLDM is for toxin production suppression purposes (suppression can also be done even when R) | |
Toxic shock syndrome | PCG: S | |||||
Viridans Streptococcus,S. gallolytics (S. bovis) | Endocarditis | PCG MIC ≤0.12 μg/mL | PCG 4,000,000 units, every 4 h [5] or ABPC 2 g, every 4–6 h [11] | CTRX [5] | PCG can be continuously infused for 24 h [5], or divided between 6-h intervals [87, 114]. PCG 2–3,000,000 units, every 4 h is also an option (native valve [87, 114], prosthetic valve [114]) | |
PCG MIC =0.25 μg/mL | “PCG 4,000,000 units, every 4 h or ABPC 2 g, every 4 h” +GM 3 mg/kg, every 24 h (or 1 mg/kg, 2–3 times per day) [5, 11, 18, 87, 114] | CTRX (if MIC ≤0.5 μg/mL) + GM | PCG can be continuously infused for 24 h [5]. Target GM levels: 3–5 μg/mL at peak, less than 1 μg/mL at trough [11, 18]. Concomitant GM for 2 weeks in case native valve, 6 weeks in case of prosthetic valve | |||
PCG MIC ≥0.5 | ||||||
Other than endocarditis (e.g., pneumonia, bacteremia, febrile neutropenia) | PCG: S | PCG 2–3,000,000 units, every 4–6 h or ABPC 2 g, every 6–8 h [5, 120] | CTRX | For PCG, there is also a method of continuous infusion for 24 h [5] | ||
PCG: I/R & CTRX: S | CTRX 2 g, every 24 h [120] | |||||
PCG: I/R & CTRX: R & VCM: S | VCM initial dose 25–30 mg/kg,subsequent doses 15–20 mg/kg, every 12 h [120] | |||||
Enterococcussp. | Endocarditis | PCG: S | (1) When MIC≤500 μg/mL in high-level GM resistance tests: “PCG 4,000,000 units, every 4 h or ABPC 2 g, every 4 h” + GM 3 mg/kg, every 24 h (or 1 mg/kg, 2–3 times per day) [5, 11, 87, 114] (2) GM MIC > 500 μg/mL, or when there is no combined use of GM: ABPC 2 g, every 4 h + CTRX 2 g, every 12 h [5, 11, 87, 114] | Implement high-level resistance test of GM for endocarditis. Target GM levels: 3–5 μg/mL at peak, less than 1 μg/mL at trough [11, 18] | ||
PCG: R (MIC ≥16 μg/mL)& VCM: S | When MIC≤500 μg/mL in high-level GM resistance tests: VCM initial dose 25–30 mg/kg,subsequent doses 15–20 mg/kg, every 12 h [18] + GM 3 mg/kg, every 24 h (or 1 mg/kg, 2–3 times per day) [5, 11] | Target GM levels: 3–5 μg/mL at peak, less than 1 μg/mL at trough [11, 18] Target VCM trough levels: 15–20 μg/mL [11, 18] | ||||
VCM: R(VRE) | Consultation with infectious disease specialist also necessary | |||||
Other than endocarditis | PCG: S | PCG 3,000,000 units, every 4 h or ABPC 2 g, every 4–6 h [5] | ||||
PCG: R & VCM: S | VCM initial dose 25–30 mg/kg,subsequent doses 15–20 mg/kg, every 12 h [18] | |||||
Gram-positive rods [GPR] | ||||||
Bacillussp. (other than Bacillus anthracis) | Catheter-related bloodstream infections, etc. | VCM: S | VCM initial dose 25–30 mg/kg,subsequent doses 15–20 mg/kg, every 12 h [5, 18] | CLDM [5] | ||
Corynebacteriumsp. | Catheter-related bloodstream infections, prosthetic infections, etc. | VCM: S | VCM initial dose 25–30 mg/kg,subsequent doses 15–20 mg/kg, every 12 h [5, 18] | PCG (if S) or TEIC or LZD (if S) [5] | ||
Listeria monocytogenes | Meningitis | ABPC: S | ABPC 2 g, every 4 h [5] ± GM 1.7 mg/kg, every 8 h | ST or “ABPC+ST” | Consultation with infectious disease specialist also necessary for concomitant use | |
Nocardiasp. | Severe pneumonia / brain abscess / disseminated infection | (Routine susceptibility tests are difficult to implement, so antibacterial drug options are shown for severe cases with suspected Nocardia) | “ST trimethoprim 240–320 mg, every 8 h + IPM/CS 0.5 g, every 6 h” or “IPM/CS 0.5 g, every 6 h + AMK 15 mg/kg, every 24 h” [5, 121] | LZD, MEPM, CTRX, MINO | Consultation with infectious disease specialist also necessary. LZD is usually S. ST is rarely R, but room for debate regarding correlation between susceptibility tests and clinical effects. ST: trimethoprim 15 mg/kg/day ≒Japanese ST mixture (1 tablet or 1 g of trimethoprim is 80 mg) 3–4 tablets or 3–4 g, every 8 h | |
Gram-negative cocci [GNC] | ||||||
Neisseria meningitidis | Meningitis, bacteremia | PCG: S (MIC < 0.1 mg/mL) | PCG 4,000,000 units, every 4 h or ABPC 2 g, every 4 h [5, 119] | CTRX | ||
PCG: R | ||||||
Gram-negative rods (Enterobacteriaceae) [GNR (1)] | ||||||
Escherichia coli,Proteus mirabilisNote:See section onEnterobacterforProteus vulgaris Enterobacter | Urinary tract infection, bacteremia, etc. (excluding meningitis) | ABPC: S | ABPC 1–2 g, every 6 h [122] | CPFX (if S) or ST (if S) | ||
ABPC: R & CEZ: S | ||||||
ABPC: R & CEZ: R & CTRX(CTX): S | ||||||
ESBL-producing bacteria “CTRX(CTX): R or CAZ: R”& “MEPM:S & TAZ/PIPC: S & CMZ: S” | CMZ 1–2 g, every 8 h [7, 8, 126] TAZ/PIPC 4.5 g, every 6–8 h [9, 127] MEPM 1 g, every 8 h [5, 123, 125] | Reports indicating that CMZ and TAZ/PIPC were clinically stable and can be an option for pyelonephritis | ||||
Either MEPM or IPM/CS are not S | Consult an infectious disease specialist | |||||
Meningitis | CTRX: S | Avoid CEZ for meningitis | ||||
CTRX: R & MEPM: S | MEPM 2 g, every 8 h [89] | |||||
Either MEPM or IPM/CS are not S | Consult an infectious disease specialist | |||||
Klebsiellasp. | Urinary tract infection, pneumonia, liver abscess, etc. | ・ABPC: even S is naturally resistant, so ABPC is not selected. ・Similar with Escherichia coli in cases other than ABPC, so see section on “Escherichia coli, Proteus” mentioned above. ・Observational studies showing that CTRX has better performance than CEZ even with CEZ:S for invasive liver abscess syndrome [128]. | ||||
Enterobactersp.,Citrobactersp.,Serratia marcescens,Proteus vulgaris,Morganellasp. | Bacteremia, pneumonia, etc. (excluding meningitis) | 「CTRX(CTX): S & CAZ: S」& CFPM: S | CFPM (1 g, every 8 h or 2 g, every 8–12 h) [5, 123, 125, 129] TAZ/PIPC 4.5 g, every 6–8 h [125] or CTRX 1–2 g, every 24 h [5, 123, 125] | MEPM or CPFX (if S) or ST(if S) | ABPC is naturally resistant. CTRX, CAZ, and TAZ/PIPC have the potential to become resistant during treatment due to AmpC cephalosporinase production during treatment. Caution is required with cholangitis associated with biliary tract malignancies [130] | |
「CTRX(CTX): R or CAZ: R」 | CFPM: S & MEPM: S | CPFX (if S) or ST(if S) | ||||
CFPM: R & MEPM: S | ||||||
Either MEPM or IPM/CS are not S | Consult an infectious disease specialist | Serratia is naturally resistant to colistin | ||||
Meningitis | CFPM: S | CFPM 2 g, every 8 h [89] | Also consult an infectious disease specialist. CTRX is also an option for C. koseri. | |||
MEPM: S | ||||||
Either MEPM or IPM/CS are not S | Consult an infectious disease specialist. | Serratia is naturally resistant to colistin. | ||||
Salmonellasp. (other than abdominal typhus) | Bacteremia, extra-intestinal infections (e.g., mycotic aneurysms) | ABPC: S | ABPC 2 g, every 6 h [131] | CPFX (if S) | ||
ABPC: R & CTRX: S | CTRX 2 g, every 24 h [131] | 2 g, every 12 h for meningitis | ||||
ABPC: R & CTRX: R & MEPM: S | MEPM 1 g, every 8 h [131] | 2 g, every 8 h for meningitis | ||||
Gram-negative rods (non-glucose fermenting bacteria) [GNR (2)] | ||||||
Pseudomonas aeruginosa | Pneumonia, urinary tract infection, bacteremia, febrile neutropenia, etc. (excluding meningitis) | CAZ: S | MEPM (if S) or CPFX (if S) | |||
CFPM: S | CFPM 2 g, every 8–12 h(or 1 g, every 8 h) [ 67, 122] | |||||
PIPC: S | PIPC 4 g, every 6 h [5] | PIPC susceptibility criteria set when at least 3 g is used every 6 h [123] | ||||
All of the above and R & MEPM: S | CPFX (if S) | |||||
Either MEPM or IPM/CS are not S | Consult an infectious disease specialist | |||||
Meningitis | CAZ: S or CFPM: S | CAZ 2 g, every 8 h or CFPM 2 g, every 8 h [89] | ||||
MEPM: S | MEPM 2 g, every 8 h [89] | |||||
Acinetobacter baumannii | Hospital-acquired pneumonia / ventilator-associated pneumonia, wound infection | CFPM: S | CFPM 2 g, every 8 h [5] | CPFX (if S) or MINO (if S) | ||
SBT/ABPC: S | At least SBT/ABPC 3 g, every 6 h (consult an infectious disease specialist for severe cases) [5, 132] | SBT part exerts antibacterial effect | ||||
MEPM: S | MEPM 1 g, every 8 h [123] | |||||
Either MEPM or IPM/CS are not S | Consult an infectious disease specialist | |||||
Stenotrophomonas maltophilia | Bacteremia, pneumonia | ST: S | 240–320 mg, every 8 h as ST trimethoprim [5] | MINO [5]or CPFX(if S) | Naturally resistant to carbapenem. ST: trimethoprim 15 mg/kg/day ≒Japanese ST mixture (1 tablet or 1 g of trimethoprim is 80 mg) 3–4 tablets or 3–4 g, every 8 h | |
Gram-negative rods (others) [GNR (3)] | ||||||
Haemophilus influenzae | Meningitis | ABPC: S | CTRX [89] | |||
ABPC: R & CTRX(CTX): S | CFPM [89] | |||||
Pneumonia, epiglottitis | ABPC: S | ABPC 2 g, every 6 h [5] | ||||
ABPC: R & SBT/ABPC: S | SBT/ABPC 3 g, every 6 h [5] | |||||
ABPC: R & CTRX(CTX): S | CTRX 1–2 g, every 24 h [5] | |||||
Pasteurella multocida,Capnocytophaga canimorsus | Animal bite | PCG: S | SBT/ABPC 3 g, every 6 h [73] | CTRX | PCG 4,000,000 units every 4 h for infections due to single bacteria | |
PCG: R & SBT/ABPC: S | SBT/ABPC 3 g, every 6 h [73] | CTRX | ||||
Aeromonassp. | Soft tissue infection, bacteremia | CTRX: S or MINO: S | CTRX 2 g, every 24 h + MINO 100 mg, every 12 h [73] | CPFX+MINO, LVFX | ||
Vibrio vulnificus | Soft tissue infection, bacteremia | CTRX: S & MINO: S | CTRX 2 g, every 24 h + MINO 100 mg, every 12 h [73] | CTX + CPFX, LVFX | Observational studies have indicated that single β-lactams had a higher mortality rate than combination therapy [133] | |
Obligate anaerobic bacteria | ||||||
Obligate anaerobic bacteria (other thanC. difficile) | Polymicrobial infections | ・The extent to which undetected obligate anaerobic bacteria that should be covered depends on whether drainage was sufficient. ・Antibacterial drug selections for polymicrobial infections caused by obligate anaerobic bacteria not only are determined by the susceptibility results of detected anaerobic bacteria but also involves the estimation of mixed infection by multiple anaerobic and aerobic bacteria. ・Obligate anaerobic bacteria have the three following characteristics depending on the susceptibility rate. (1) Most obligate anaerobic bacteria above the diaphragm (e.g., Peptostreptococcus sp., Prevotella sp.) are susceptibile to β-lactams represented by PCG and CLDM. However, some include β-lactamase-producing bacteria and CLDM-resistant bacteria (e.g., some Prevotella). (2) Obligate anaerobic bacteria below the diaphragm (e.g., Bacteroides sp.) include β-lactamase-producing bacteria. The resistance rates of non-fragilis Bacteroides(other than B. fragilis) in particular against CLDM and CMZ have been increasing. (3) Most obligate anaerobic bacteria which include (1) and (2) are susceptibile to SBT/ABPC, TAZ/PIPC, MEPM, and MNZ. ・Therefore, the two following points should be considered when selecting a target therapeutic drug for polymicrobial infections where obligate anaerobic bacteria contribute: (1) To what extent obligate anaerobic bacteria are covered based on information about whether it is above or below diaphragm or drainage is sufficient, and (2) Causative bacteria other than obligate anaerobic bacteria are covered. | ||||
Peptostreptococcussp.,Prevotellasp. (obligate anerobic bacteria above the diaphragm) | Lung abscess, deep cervical infection, etc. | The right shows typical options. Susceptibility results of detected bacteria other than obligate anaerobic bacteria can also serve as a reference for selection. | SBT/ABPC 3 g, every 6 h or CLDM 600 mg, every 8 h or “MNZ 500 mg, every 8 h + (PCG 2–3,000,000 units, every 4 h or CTRX 2 g, every 24 h” [134] | TAZ/PIPC | ||
Brain abscess | “(PCG 4,000,000 units, every 4 h or CTRX 2 g, every 12 h or CFPM 2 g, every 8 h) + MNZ 500 mg, every 8 h” [66] | |||||
Bacteroidessp. (obligate anerobic bacteria below the diaphragm) | Polymicrobial intra- abdominal infection (secondary peritonitis, intraperitoneal abscess, cholangitis) | Insufficient drainage | The right shows typical options. Susceptibility results of detected bacteria other than obligate anaerobic bacteria can also serve as a reference for selection. | SBT/ABPC 3 g, every 8 h or TAZ/PIPC 4.5 g, every 8 h or “MNZ 500 mg, every 8 h + (CEZ 2 g, every 8 h or CTRX 2 g, every 24 h or CFPM 2 g, every 12 h or CPFX 400 mg, every 12 h)“ [5] | MEPM | CMZ: R and CLDM: R are increasing [5] |
Sufficient drainage | CMZ 1 g, every 8 h or 「CLDM 600 mg, every 8 h + (CEZ 2 g, every 8 h or CTRX 2 g, every 24 h or CFPM 2 g, every 12 h or CPFX 400 mg, every 12 h)” or “insufficient drainage” option in previous section [5] | |||||
Clostridiumsp. (e.g.,C. perfringens) | Gas gangrene | PCG: S | PCG 4,000,000 units, every 4 h +CLDM 600 mg, every 8 h [5, 73] | CLDM is for toxin production suppression purposes (suppression can also be done even when R) [5] | ||
Clostridioides (Clostridium) difficile | ||||||
Clostridioides (Clostridium) difficile | Clostridioides difficile infection (CDI) | Initial onset | VCM 125 mg, four times a day (orally or through nasogastric tube) [5, 135] | Non-severe: MNZ orally | Intravenous VCM is ineffective | |
Initial onset | VCM tapering regimen (starting at 125 mg, four times a day) or FDX 200 mg, two times a day [135] | When initial treatment is MNZ: VCM | ||||
Shock, hypotension, megacolon, ileus, VCM 125 mg regimen is ineffective | “VCM 500 mg, every 6 h (orally or through nasogastric tube) 500 mg / saline 100 mL as stationary enema through anus for ileus” ±MNZ 500 mg, intravenously every 8 h [135] | |||||
Other bacteria | ||||||
Legionellasp. | Pneumonia | LVFX 500–750 mg, every 24 h [5] or AZM 500 mg, every 24 h [5] | MINO [20] | |||
Mycoplasma pneumoniae | Pneumonia | MINO 100 mg, every 12 h [5] | AZM or LVFX | |||
Rickettsia japonica | Japanese spotted fever | MINO 100 mg, every 12 h [13] | CPFX | |||
Orientia tsutsugamushi | Scrub typhus | MINO 100 mg, every 12 h [13] | AZM | CPFX is ineffective | ||
Leptospira interrogans | Leptospirosis | PCG 1500,000 units, every 6 h [136] | CTRX or MINO | |||
Fungi | ||||||
Candida | Candidemia, disseminated candidiasis (includes febrile neutropenia) | ・Empirical treatment (normally MCFG) should be stepped down to oral FLCZ or VRCZ mentioned below if blood culture negativity and clinical stability are confirmed. ・Complications of endophthalmitis should involve switching to FLCZ or VRCS since MCFG has poor intraocular penetration (L-AMB ± 5-FC if there is resistance to FLCZ and VRCZ). ・Most of C. albicans, parapsilosis, and tropicalis are susceptible to FLCZ, C. glabrata is either susceptible or resistant, and C. krusei is naturally resistant. The difficult-to-identify C. auris (can be FLCZ resistant or multi-drug resistant) has been recently reported. ・Most cases of candiduria are not treated; however, candidemia and disseminated candidiasis can be diagnosed as a result of candiduria. An infectious disease specialist should also be consulted when candiduria requires treatment (MCFG and L-AMB have poor urinary tract penetration). | ||||
Candida albicans, C. parapsilosis, C. tropicalis | After stabilization of candidemia | FLCZ: S | FLCZ initial dose 800 mg(subsequent doses 400 mg), every 24 h [137] | |||
C. glabrata | FLCZ: S | FLCZ initial dose 800 mg(subsequent doses 400 mg), every 24 h [137] | Completing treatment as only MCFG is also an option. Consult an infectious disease specialist | |||
FLCZ: R & VRCZ: S | VRCZ initial dose 6 mg/kg, every 12 h (subsequent doses 4 mg/kg, every 12 h) [137] | |||||
C. krusei | FLCZ: R & VRCZ: S | VRCZ initial dose 6 mg/kg, every 12 h (subsequent doses 4 mg/kg, every 12 h) [137] | ||||
Aspergillussp. | Invasive pulmonary aspergillosis | VRCZ initial dose 6 mg/kg, every 12 h (subsequent doses 4 mg/kg, every 12 h) [5, 137] | L-AMB [20] | |||
Pneumocystis jirovecii | Pneumocystis | 240–320 mg as ST trimethoprim, every 8 h [5], | Intravenous infusion of pentamidine [5] | ST: trimethoprim 15 mg/kg/day ≒Japanese ST mixture (1 tablet or 1 g of trimethoprim is 80 mg) 3–4 tablets or 3–4 g, every 8 h | ||
Cryptococcussp. | Meningitis (non-HIV) | L-AMB 3–4 mg/kg, every 24 h + 5-FC 25 mg/kg orally, every 6 h [137] | FLCZ (high dose) | |||
Mucorsp., etc. | Mucormycosis | L-AMB 5–10 mg/kg, every 24 h [137] | ||||
Virus | ||||||
Influenza | Pneumonia, etc. | Oseltamivir 75 mg orally, twice a day [138] | Peramivir | |||
SFTS | Severe fever with thrombocytopenia syndrome | Undergoing research [139] | ||||
CMV | Pneumonia, etc. | Ganciclovir 5 mg/kg, every 12 h [5] | Foscarnet | |||
HSV | Pneumonia, etc. | Acyclovir 10 mg/kg, every 8 h [140] | ||||