What Is the Treatment of Cytomegalovirus Pneumonia?
Cytomegalovirus (CMV) pneumonia is a serious pulmonary infection presenting with fever, cough or dyspnea, and diffuse pulmonary interstitial infiltrates. Guideline-directed antiviral therapy is the cornerstone of management, with clearly defined goals and minimum treatment duration.
Clinical Treatment Goals
The objective is complete resolution of the defining features of CMV pneumonia — fever, cough or dyspnea, and diffuse pulmonary interstitial infiltrates — sustained over a minimum course of therapy until signs and symptoms have fully resolved.
Treatment Approach — Partial Overview
Management is anchored by intravenous antiviral therapy, with a preferred first-choice agent and a defined alternative for patients unable to receive it. Under specific clinical conditions, a transition to oral therapy may be considered. The complete agent selection, criteria for transition, and minimum duration are specified in the full structured protocol.
References
- Treatment with IV ganciclovir or, alternatively, with foscarnet, is recommended (BIII).
- Ganciclovir 5 mg/kg IV every 12 hours (BIII)
- Foscarnet 60 mg/kg IV every 8 hours or 90 mg/kg IV every 12 hours (BIII)
- The role of oral valganciclovir has not been established, but based on clinical experience with SOT, transition to oral valganciclovir can be considered if CMV pneumonia is not life-threatening and oral medications can be absorbed (BIII).
- ≥21 days or until signs and symptoms have resolved (CII)