Cytomegalovirus (CMV) gastroenteritis and hepatitis requires timely antiviral therapy aimed at resolving gastrointestinal signs and symptoms. When the initial treatment line does not reach this goal — or cannot be continued due to toxicity — a defined alternative regimen applies.
The first-line approach uses ganciclovir, with the option to transition to valganciclovir once the patient is able to absorb and tolerate oral therapy. Escalation is indicated when this approach fails to achieve resolution of gastrointestinal signs and symptoms of CMV disease, or when treatment-limiting toxicity prevents its continuation.
When ganciclovir cannot be tolerated or has not controlled the infection, alternative intravenous antiviral agents are available. The protocol specifies agents that require structured hydration support before and after infusion, along with additional protective measures. The full sequence — including agent selection criteria, infusion scheduling, and hydration protocol — is specified in the complete structured regimen.
The treatment target is resolution of gastrointestinal signs and symptoms of CMV disease. Therapy is continued for 21–42 days or until signs and symptoms have resolved.