This protocol applies to patients with cytomegalovirus (CMV) retinitis whose retinal necrotic lesions have not resolved following a completed course of first-line antiviral therapy with ganciclovir or valganciclovir.

First-Line Treatment — Failure Condition

Initial treatment with ganciclovir (intravenous) or oral valganciclovir did not achieve the required endpoint: disappearance of the retinal necrotic lesion on fundus photograph after 2 weeks of anti-CMV therapy. This next-line protocol is triggered by that failure.

Next-Line Treatment — Partial Overview

When ganciclovir resistance underlies first-line failure, an antiviral active against resistant CMV strains — such as cidofovir — may be selected, with further options available for both systemic and local administration. The complete regimen, selection criteria, and therapeutic sequencing are contained in the full structured protocol.

References

DOI: 10.3390/v16091427

It is suitable for treating patients with GCV resistance, and its lower cost makes CDV advantageous for managing resistant CMV infections.
FOS, with a different mechanism of action than GCV, serves as an alternative treatment option for intravenous and intravitreal administration, particularly for drug-resistant patients.
If CMV antigenemia remains detectable, a maintenance dose of 90 mg/kg/day IV over 3 h is recommended until antigenemia clears.

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CMV Retinitis Not Responding to Ganciclovir: Next-Line Management