infectious diseases
Mpox (Monkeypox)
Treatment of Mpox
Most patients with mpox have mild, self-limited disease. This is particularly true for the West African clade responsible for the current global outbreak. Treatment is supportive with analgesics, fluids, and wound care. Patients with severe disease, complications, or who are at risk for severe disease should be considered for antiviral treatment. This includes patients with hemorrhagic or confluent lesions, mucosal or genital involvement, or other complications requiring hospitalization; immunocompromised, pediatric, pregnant or breastfeeding patients; and patients with active exfoliative skin conditions. There is no proven, safe treatment specifically for mpox virus infection. However, the following treatment options are available: The antiviral drugtecovirimat: Approved by the US Food and Drug Administration [FDA] for the treatment of smallpox—available in oral and IV formulations from the CDC via an Expanded Access Investigational New Drug (IND) protocol for the primary or early empiric treatment of mpox in all ages; approved for smallpox and mpox in the European Union The antiviral drugscidofovir(commercially available) orbrincidofovir(CMX001, available via single-patient emergency use IND) Vaccinia immune globulin(IV), available from the CDC via an Expanded Access IND protocol Trifluridineophthalmic solution for ocular lesions All of these drugs have activity against mpox in vitro and in experimental models, but there are no data available yet that demonstrate clinical effectiveness. They have been used extensively during the current outbreak, and clinical trials are ongoing. The CDC developed a treatment consideration algorithm in March 2023 based on the available evidence and experience ( References ). (See also 1.Rao AK, Schrodt CA, Minhaj FS, et al: Interim Clinical Treatment Considerations for Severe Manifestations of Mpox — United States, February 2023.MMWR Morb Mortal Wkly Rep72:232–243, 2023. doi: 10.15585/mmwr.mm7209a4 