CMV (Cytomegalovirus) retinitis
Advices
| Priority | Medication | Remarks |
|---|---|---|
|
Priority: 1st choice |
Medication: valganciclovir po 900mg 2dd minimum 14 days |
Remarks:
Indien er geen sprake is van systemische CMV ziekte (o.a. colitis, pneumonitis, hoge CMV viral load in plasma). |
|
Priority: 1st choice alternative |
Medication: ganciclovir iv 5mg/kg 2dd minimum 14 days |
Remarks:
In geval van systemische CMV ziekte (o.a. colitis, pneumonitis, hoge CMV viral load in plasma) wordt geadviseerd met IV therapie te starten. |
| Priority | Medication | Remarks |
|---|---|---|
|
Priority: 1st choice |
Medication: valganciclovir po 900mg 2dd minimum 14 days +
ganciclovir intravitreal 2mg |
Remarks:
Indien er geen sprake is van systemische CMV ziekte (o.a. colitis, pneumonitis, hoge CMV viral load in plasma). Ganciclovir intravitreale injectie 2 mg = 0,1 mL (20 mg/mL); zonodig (wekelijks) herhalen. |
|
Priority: 1st choice alternative |
Medication: ganciclovir iv 5mg/kg 2dd minimum 14 days +
ganciclovir intravitreal 2mg |
Remarks:
In geval van systemische CMV ziekte (o.a. colitis, pneumonitis, hoge CMV viral load in plasma) wordt geadviseerd met IV therapie te starten. Ganciclovir intravitreale injectie 2 mg = 0,1 mL (20 mg/mL); zonodig (wekelijks) herhalen. |
| Priority | Medication | Remarks |
|---|---|---|
|
Medication: foscarnet iv 90mg/kg 2dd minimum 14 days |
Remarks:
In geval van recurrende of refractaire CMV retinitis voeg toe: forscarnet intravitreale injectie 2,4 mg = 0,1 mL; zo nodig (wekelijks) herhalen. |
Sources
- Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV: Cytamegalovirus Disease.
-
Pubmed.gov publication # 33187478
Murray J, Hilbig A, Soe TT, Ei WLSS, Soe KP, Ciglenecki I. Treating HIV-associated cytomegalovirus retinitis with oral valganciclovir and intra-ocular ganciclovir by primary HIV clinicians in southern Myanmar: a retrospective analysis of routinely collected data. BMC Infect Dis. 2020 Nov 13;20(1):842. doi: 10.1186/s12879-020-05579-2. PMID: 33187478; PMCID: PMC7666479.
-
Pubmed.gov publication # 22044356
Vadlapudi AD, Vadlapatla RK, Mitra AK. Current and emerging antivirals for the treatment of cytomegalovirus (CMV) retinitis: an update on recent patents. Recent Pat Antiinfect Drug Discov. 2012 Apr;7(1):8-18. doi: 10.2174/157489112799829765. PMID: 22044356; PMCID: PMC4516169.
-
Pubmed.gov publication # 25999800
Tan BH. Cytomegalovirus Treatment. Curr Treat Options Infect Dis. 2014;6(3):256-270. doi: 10.1007/s40506-014-0021-5. PMID: 25999800; PMCID: PMC4431713.
-
Pubmed.gov publication # 11948271
Martin DF, Sierra-Madero J, Walmsley S, Wolitz RA, Macey K, Georgiou P, Robinson CA, Stempien MJ; Valganciclovir Study Group. A controlled trial of valganciclovir as induction therapy for cytomegalovirus retinitis. N Engl J Med. 2002 Apr 11;346(15):1119-26. doi: 10.1056/NEJMoa011759. Erratum in: N Engl J Med 2002 Sep 12;347(11):862. PMID: 11948271.
-
Pubmed.gov publication # 16737936
Winston DJ, Baden LR, Gabriel DA, Emmanouilides C, Shaw LM, Lange WR, Ratanatharathorn V. Pharmacokinetics of ganciclovir after oral valganciclovir versus intravenous ganciclovir in allogeneic stem cell transplant patients with graft-versus-host disease of the gastrointestinal tract. Biol Blood Marrow Transplant. 2006 Jun;12(6):635-40. doi: 10.1016/j.bbmt.2005.12.038. PMID: 16737936.
- UMCG Protocol CMV retinitis
Antimicrobial resources
The following antimicrobial agents have been used in these recommendations:
External antimicrobial resources
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Metadata
Swab vid: G-502233.1
Updated: 04/04/2024 - 12:25
Status: Published
General comments
Bij vermoede/aangetoonde ganciclovir resistentie of bij ganciclovir toxiciteit: overleg met viroloog.
NB na behandeling secundaire profylaxe!