Congenital Cytomegalovirus Disease

Patient Population: Pediatric
Condition Major Pathogens  First-choice Therapy Alternative Therapy Comments

Symptomatic congenital CMV disease  

Diagnosed based on detection of CMV in the urine or saliva within the first 3 weeks of life 


Moderately to severely symptomatic

Multiple manifestations attributable to CMV infection: thrombocytopenia, petechiae, hepatomegaly, splenomegaly, intrauterine growth restriction, hepatitis 

CNS involvement such as microcephaly, radiographic abnormalities consistent with CMV-related CNS disease (ventriculomegaly, calcifications, periventricular echogenicity, cortical or cerebellar malformations), abnormal CSF indices for age, chorioretinitis, or detection of CMV DNA in CSF  

See 2nd column for continued categories 



Symptom classification continued from 1st column:  

Mildly symptomatic

1-2 isolated manifestations that are mild and transient, occurring in isolation (e.g. single measurement of low platelet count) 

Asymptomatic congenital CMV infection with isolated sensorineural hearing loss (SNHL):  

Sensorineural hearing loss, with no other apparent abnormalities 

Asymptomatic congenital CMV infection

No apparent abnormalities to suggest congenital CMV disease, and normal hearing 

Asymptomatic with normal hearing:  
Treatment not recommended  

Mildly symptomatic, or asymptomatic with isolated SNHL, or diagnosed after first month of life
Current guidelines do not recommend  treatment routinely. Consult ID for individualized assessment.  

Moderate to severely  symptomatic, within first month of life, gestational age >= 32 weeks:  

16 mg/kg/dose enterally bid 

Adjust dose monthly to account for weight gain 

Moderate to severely  symptomatic, within first month of life, gestational age <32 weeks
Consult ID for individualized management & medication dosing 

Unable to take enteral medication: 


6 mg/kg/dose IV q12h  

ID consult recommended. Multiple follow-up evaluations are recommended, recommendations here focused on treatment with antivirals only 

Monitoring During Therapy:  
Absolute neutrophil count weekly x 6 weeks, at 8 weeks, then monthly for duration of therapy 


AST, ALT monthly 

Duration: 6 months 


Rawlinson WD, et al. Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy. Lancet Infectious Diseases 2017;17:e177-88.

American Academy of Pediatrics. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021 Report of the Committee on Infectious Diseases. 32nd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2021.  

Pediatric Empiric Antimicrobial Therapy Guidelines

This is a subsection of the UCSF Benioff Children’s Hospitals Empiric Antimicrobial Therapy Guidelines, developed by the Pediatric Antimicrobial Stewardship Programs at each campus to inform initial selection of empiric antimicrobial therapy for children at the UCSF Benioff Children’s Hospitals and affiliated outpatient sites. 

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. Durations provided are usual recommendations for patients who are responding appropriately to therapy. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP) at the campus where your patient is receiving care.  

For questions or feedback about these guidelines, please email primary content owners, Rachel Wattier, Pediatric ASP Medical Director at BCH SF and Prachi Singh, Pediatric ASP Medical Director at BCH OAK. 

The content of these guidelines was updated in July 2021. See Summary and Rationale for Changes (password login to Box needed) for detailed explanations of the content changes.