Infection	Treatment	Prophylaxis
CMV	Reduction of immunosuppressive agents likely required	Ganciclovir (Cytovene) or valganciclovir (Valcyte) for three months posttransplant except in CMV-negative recipient/CMV-negative donor pairs and for six weeks after treatment with T lymphocyte–depleting antibody
Epstein-Barr virus	Reduction of immunosuppressive agents	—
Fungal infections	Antifungals and reduction of immunosuppressive agents	Liver recipients (high risk of infection): invasive Candida prophylaxis with fluconazole (Diflucan), itraconazole (Sporanox), caspofungin (Cancidas), or amphotericin B for one to three months posttransplant and one month after treatment with T lymphocyte–depleting antibody
		Kidney and heart recipients: oral and esophageal Candida prophylaxis with oral clotrimazole lozenges, nystatin, or fluconazole for one to three months posttransplant or one month after treatment with T lymphocyte–depleting antibody
Herpes simplex virus and VZV	Superficial infections: oral antivirals until lesions resolve	Susceptible patients should receive prophylaxis after exposure to active VZV with VZV immune globulin (within 96 hours) or oral antivirals (after 96 hours)
	Disseminated or systemic infections: intravenous antivirals and reduction of immunosuppressive agents until response, then transition to oral agents to complete 14- to 21-day course
Pneumocystis jiroveci	High-dose TMP/SMX with reduction in immunosuppressive agents for at least 14 days; corticosteroids may be used as adjunct in patients with significant hypoxia	TMP/SMX posttransplant (duration depends on organ; heart: unspecified; kidney: three to six months; liver: six to 12 months)
		Alternatively, can use dapsone or atovaquone (Mepron)
		Kidney recipients: six weeks during and after treatment for acute rejection
Tuberculosis	Standard treatment regimen; rifampin can decrease levels of calcineurin and mammalian target of rapamycin inhibitors	Consider in patients with latent tuberculosis, intensified immunosuppression, diabetes mellitus, or CMV, P. jiroveci, Nocardia, or fungal coinfections; isoniazid is preferred prophylactic agent