Mild CMV Colitis When Oral Valganciclovir Has Not Achieved Resolution
Clinical Scenario
This protocol applies to patients with mild cytomegalovirus (CMV) colitis whose signs and symptoms have not resolved despite completion of an initial oral treatment course.
Previous Treatment — Goal Not Met
The prior line used oral valganciclovir over a course of up to 21–42 days. The intended endpoint was complete resolution of CMV colitis signs and symptoms within that window. This protocol is the next step when that goal was not achieved.
Treatment Goal
Resolution of signs and symptoms of CMV colitis within 21–42 days.
Next-Line Approach (Overview)
This protocol moves to intravenous antiviral therapy. The complete structured regimen — including agent selection, supportive measures, and monitoring — is available via the link below.
References
- Valganciclovir 900 mg PO every 12 hours can be used in patients with mild disease (AIII).
- Oral valganciclovir can be used in patients with mild disease (AIII).
- Foscarnet 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 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).
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