Treatment of active disease in adults
See Approach to treating cytomegalovirus disease before starting antiviral therapy. For information on drug selection, including switch from intravenous to oral therapy, see c_abg16-c21-s3.html#abg16-c21-s3__tabg16-c21-tbl2.
For treatment of active cytomegalovirus (CMV) disease in adults, when initial intravenous therapy is indicated, and ganciclovir resistance is not suspected, use:
ganciclovir 5 mg/kg intravenously, 12-hourly. For dosage adjustment in adults with kidney impairment, see ganciclovir treatment dosage adjustment. cytomegalovirus disease, treatment (adult) ganciclovir
When initial oral therapy is indicated, or when clinical improvement has occurred and a switch to oral therapy is feasible, use:
valganciclovir 900 mg orally, 12 hourly. For dosage adjustment in adults with kidney impairment, see valganciclovir treatment dosage adjustment. cytomegalovirus disease, treatment (adult) valganciclovir
If ganciclovir is contraindicated or CMV resistance is proven by resistance testing or CMV resistance is suspected due to a failure in clinical response, failure to control CMV viraemia or a rebound in CMV viraemia, use:
foscarnet 90 mg/kg intravenously, 12-hourly. For dosage adjustment in adults with kidney impairment, see foscarnet dosage adjustment. cytomegalovirus disease, treatment (adult) foscarnet
If ganciclovir and foscarnet are not suitable, use:
cidofovir 5 mg/kg intravenously, weekly; administer with probenecid (see cidofovir product information for dosage of probenecid)1. For dosage adjustment in adults with kidney impairment, see cidofovir dosage adjustment. cytomegalovirus disease, treatment (adult) cidofovir
Duration of therapy is determined by response to treatment, which is defined clinically and with suppression of CMV viraemia; for more information, see Approach to treating cytomegalovirus disease.
In patients with HIV who are taking antiretroviral therapy, check for potential drug interactions when prescribing therapy for CMV disease (see Antiretroviral drug interactions).