Review
Copyright ©2011 Baishideng Publishing Group Co.
World J Hepatol. Apr 27, 2011; 3(4): 83-92
Published online Apr 27, 2011. doi: 10.4254/wjh.v3.i4.83
Table 2 Suggested prevention and treatment regimens for various infections after liver transplantation
InfectionPreventionTreatment
Bacterial infectionsAccording to risk factors (i.e. cephalosporins or vancomycin)Susceptibility-guided antimicrobial treatment
Herpes simplex virusAcyclovir 400 mg PO BID for 4 wk (if they are not receiving drugs for CMV prevention)Acyclovir 5 mg/kg every 8 h for mucocutaneous disease or 10 mg/kg every 8 h for encephalitis
Valacyclovir 1 gram PO BID for less severe disease
CytomegalovirusValganciclovir 900 mg daily for 3-6 moValganciclovir PO 900 mg BID or ganciclovir IV 5 mg/kg BID.
Oral ganciclovir, 1 gram TID for 3-6 moIf severe or life-threatening disease, initiate therapy with IV ganciclovir.
Preemptive therapy (guided by CMV PCR or antigenemia)Treatment must continue until viral eradication is achieved, but not shorter than 2 wk
CMV Ig may be considered for severe forms of disease like pneumonitis.
Varicella zoster virusPre-transplant vaccinationValacyclovir 1-gram PO TID or IV acyclovir 10 mg/kg every 8 h
Initiate with IV acyclovir for disseminated disease such as pneumonia or encephalitis
VZV immunoglobulin adds no additional benefits and not recommended
Candida speciesFluconazole, echinocandin, or amphotericin B in high-risk recipients for 4 weeksAmphotericin B 3 to 5 mg/kg IV daily
Fluconazole 800 mg loading dose, then 400 mg PO daily
Caspofungin at an initial dose of 70 mg followed by 50 mg daily
Anidulafungin initial dose of 200 mg first day followed by 100 mg daily
Aspergillus speciesVoriconazole, echinocandin, or amphotericin B in high-risk patientsVoriconazole 6 mg/kg IV BID on day 1 followed by 4 mg/kg BID daily; transition to oral regimen when clinically stable
Echinocandins (caspofungin or anidulafungin)
Amphotericin B preparations
Cryptococcus neoformansNot recommendedAmphotericin B (conventional or liposomal) and flucytosine (5-FC) for at least 2 wk then fluconazole as long-term maintenance (e.g. 6 mo)
Fluconazole 800 mg loading dose, then 400 mg PO daily for limited disease
Pneumocystis jiroveciiTMP- SMX 160/800 mg daily or three times per weekTMP- SMX preferred; 15-20 mg/kg per day of TMP component in 3-4 divided doses (keep the sulfa level above 100); transition to oral regimen when clinically stable
Alternative: TMP-SMX 80/400 mg daily
Alternatives: Pentamidine isethionate, trimethoprim-dapsone (in patients who are not deficient in glucose-6-phosphate dehydrogenase), atovaquone, and clindamycin-primaquine.
Toxoplasma gondiiTMP- SMX 160/800 mg dailyPyrimethamine in combination with sulfadiazine or clindamycin.
Listeria monocytogenesNot recommended but TMP- SMX for Pneumocystis prophylaxis may prevent some infectionsAmpicillin 2 g IV every four hours plus Gentamicin 3 mg/kg per day IV in three divided doses
Alternatives:
TMP- SMX 10-20 mg/kg IV per day divided every 6 to 12 h
Meropenem 2 g IV every eight hours
Nocardia asteroidesNot recommended but TMP- SMX for Pneumocystis prophylaxis may prevent some infectionsTMP-SMX preferred; 8-10 mg/kg per day of TMP component in 2-4 divided doses; higher doses may be used in severe disease; transition to oral therapy when clinically stable