Maribavir (Livtencity – Takeda), an oral cytomegalovirus (CMV) pUL97 kinase inhibitor, has been approved by the FDA for treatment of post-transplant CMV infection refractory to standard antiviral therapy in patients ≥12 years old who weigh at least 35 kg.

An outbreak of monkeypox has recently spread around the globe and across the US. Updated information about the current outbreak is available from the CDC.

The FDA has approved letermovir (Prevymis – Merck), a cytomegalovirus (CMV) DNA terminase complex inhibitor, for prophylaxis of CMV infection and disease in CMV-seropositive adult recipients of an allogeneic hematopoietic cell transplant (HCT). Letermovir is the first CMV DNA terminase complex inhibitor to be approved in the US and the only drug specifically indicated for CMV prophylaxis in HCT patients. It is not approved for treatment of CMV infection.

The recommendations for treatment of varicella-zoster virus (VZV) and herpes simplex virus (HSV) infections are listed in tables 1 and 2. Vaccination against VZV was reviewed in a previous issue.

The drugs of choice for treatment of viral infections (other than HIV) and their dosages are listed in Tables 1-6 on the pages that follow. Some of the indications and dosages recommended here have not been approved by the FDA. Vaccines used for the prevention of viral infections are discussed elsewhere.

The drugs of choice for treatment of non-HIV viral infections and their dosages are listed in Tables 1-6 on the pages that follow. Some of the indications and dosages recommended here have not been approved by the FDA. Vaccines used for the prevention of viral infections are discussed in another issue of Treatment Guidelines.

The drugs of choice for treatment of non-HIV viral infections with their dosages and cost are listed in Tables 1-6. Some of the indications and dosages recommended here have not been approved by the FDA. Vaccines used in the prevention of viral infections are discussed in the "Adult Immunization" issue of Treatment Guidelines.

The drugs of choice for non-HIV viral infections with their dosages and cost are listed in the tables that begin on page 24. Some of the indications and dosages recommended here have not been approved by the FDA.

The single sentence on vaccination site care in our recent article on Smallpox Vaccination (Vol. 45, page 2) needs clarification. In the past, the vaccination site was generally left uncovered, but current plans for Phase I call for it to be covered with both gauze to absorb liquid and a semipermeable membrane such as an Opsite dressing to prevent spread of the virus. This correction has been made in the web version of the issue.

Because of concerns about the possibility of bioterrorism involving smallpox, the US government is reinstituting smallpox vaccination (https://www.cdc.gov/smallpox/; www.idsociety.org/bt/toc.htm). Vaccination is currently expected to proceed in three phases: the military and hospital smallpox response teams first, other health care workers, police and firefighters second, and the general public in the third phase. Except for the military, vaccination will be voluntary.

The drugs of choice for non-HIV viral infections with their dosages and cost are listed in the table that begins on the next page. Since the last Medical Letter issue on this subject, some new drugs and some new recommendations for old drugs have been added.

Concerns have arisen anew about possible use of biological weapons. The pathogens considered most likely to be used for this purpose are discussed in this article. A good source for additional information is www.usamriid.army.mil/education/bluebook.html.

The drugs of choice for non-HIV viral infections with their dosages and cost are listed in the [article's] table.

Concerns persist about the possible use of biological weapons. Among the many organisms found in nature that cause serious infections, only a few have the combination of pathogenicity, stability and ease of production needed to make effective biological warefare agents.

The drugs of choice for non-HIV viral infections with their dosages and cost are listed in the table on the next page. The treatment of HIV infection will be discussed in a future issue.

Four new drugs have become available in the USA for HIV infection or its complications. Nevirapine (Viramune - Roxane), intravenous cidofovir (Vistide - Gilead), and amphotericin B oral suspension (Fungizone Oral Suspension - Bristol-Myers Squibb) have been approved by the US Food and Drug Administration; nelfinavir (Viracept - Agouron) is currently available only through an "Expanded Access Program."