Neonatal Immunology Laboratory, Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia Piazzale Golgi 19, 27100 Pavia, Italy.
Curr Drug Metab. 2013 Feb;14(2):208-15.
Congenital cytomegalovirus infection is the most common cause of nonhereditary sensorineural hearing loss and an important cause of psychomotor retardation. Newborns suffering from symptomatic congenital cytomegalovirus infection have been typically treated with i.v. ganciclovir (GCV). Nowadays valganciclovir (V-GCV), a mono-valyl ester pro-drug of GCV, is available as an oral syrup. The existing literature demonstrated that V-GCV is well absorbed from the gastrointestinal tract and is rapidly converted into GCV in the intestinal wall and liver. The mechanism of antiviral action is the same that has been described for GCV. All these characteristics make this formulation particularly suitable for the symptomatic congenitally infected newborns. In neonates, V-GCV oral formulation proved stable and constant GVC plasma concentrations, in the suggested therapeutic range. The syrup demonstrated to be clinically effective and well tolerated and to be appropriate for a prolonged post-discharge therapy avoiding the discomfort of hospitalization, reducing the risk for nosocomial infections and decreasing the cost for the National Health Service. This article reviews all the available literature about V-GCV syrup in the treatment of newborns and infants with congenital CMV infection with the regard to pharmacokinetics, pharmacodynamic properties and clinical use, focussing on new data and on our experience.
先天性巨细胞病毒感染是遗传性感觉神经性听力损失的最常见原因，也是精神运动发育迟缓的重要原因。有症状的先天性巨细胞病毒感染的新生儿通常采用静脉注射更昔洛韦（GCV）治疗。如今，缬更昔洛韦（V-GCV），一种 GCV 的单缬氨酸酯前药，作为口服糖浆上市。现有文献表明，V-GCV 从胃肠道被很好地吸收，并在肠壁和肝脏中迅速转化为 GCV。抗病毒作用的机制与 GCV 描述的相同。所有这些特征使该制剂特别适用于有症状的先天性感染新生儿。在新生儿中，V-GCV 口服制剂在建议的治疗范围内证明了稳定且恒定的 GCV 血浆浓度。糖浆表现出临床疗效和良好的耐受性，适用于延长出院后的治疗，避免住院的不适，降低医院感染的风险，并降低国家卫生服务的成本。本文综述了关于 V-GCV 糖浆治疗先天性 CMV 感染新生儿和婴儿的所有现有文献，重点关注新数据和我们的经验，涉及药代动力学、药效学特性和临床应用。
