Cytomegalovirus esophagitis
ICD-10 B25.9 · ICD-11 1D82.Y.1

Treatment of Cytomegalovirus Esophagitis When Disease Is Not Mild

When cytomegalovirus (CMV) esophagitis does not qualify as mild disease, the treatment pathway differs from that used for milder presentations. This protocol defines the approach for that specific clinical scenario.

Clinical Scenario

The patient has cytomegalovirus esophagitis that is not mild disease. This severity distinction is the key determinant of the treatment strategy applied here.

Treatment Approach

Initial management relies on intravenous antiviral therapy. Once the patient is able to absorb and tolerate oral medications, treatment may be transitioned to an oral antiviral agent.

Specific agents, doses, transition criteria, and full duration are detailed in the complete protocol.
Treatment Goal

The clinical target is resolution of the signs and symptoms of CMV esophagitis, assessed over the course of treatment.

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References

  1. 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).
  2. Oral valganciclovir can be used in patients with mild disease (AIII).
  3. Ganciclovira 5 mg/kg IV every 12 hours (AI); may switch to valganciclovir 900 mg PO every 12 hours once the patient can absorb and tolerate PO therapy (AIII)
  4. 21–42 days or until signs and symptoms have resolved (AIII)
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