التهاب المريء بالفيروس المضخم للخلايا (المرض غير الخفيف): ماذا تفعل عندما يفشل العلاج المعتمد على الغانسيكلوفير؟

References

• IV ganciclovir is the therapy of choice (AI) and can be switched to oral valganciclovir once the person can tolerate and absorb oral medications, extrapolated from randomized, clinical trial data showing non-inferiority of oral valganciclovir for treatment of CMV disease in people receiving a solid organ transplant (SOT) (AIII).
• Oral valganciclovir can be used in patients with mild disease (AIII).
• Foscarnet^a 60 mg/kg IV every 8 hours or 90 mg/kg IV every 12 hours (BIII) — for patients with treatment-limiting toxicities to ganciclovir or with ganciclovir resistance; or
• Cidofovir^a,b 5 mg/kg/week IV for 2 weeks, then 5 mg/kg IV every other week.
• Administer 1 L of normal saline before and, if additional fluid load can be tolerated, administer another 1 L of normal saline after cidofovir infusion.
• Administer probenecid 2 g PO 3 hours before each cidofovir dose followed by 1 g PO 2 hours after the dose and 1 g PO 8 hours after the dose (total of 4 g) (CI).
• 21–42 days or until signs and symptoms have resolved (AIII).