Combined and alternating ganciclovir and foscarnet in acute and maintenance therapy of human immunodeficiency virus-related cytomegalovirus encephalitis refractory to ganciclovir alone. A case report and review of the literature.
Cytomegalovirus (CMV) causes life-threatening disseminated infections and in particular vision-threatening infections of the retina in patients with the acquired immunodeficiency syndrome. Ganciclovir currently represents the most frequently used therapy for CMV retinitis. However, cases of ganciclovir-resistant CMV strains have been described, in which foscarnet seems to be an effective alternative. Both drugs have serious toxicities, and relapses frequently occur during maintenance therapy. In a patient with CMV encephalitis, we administered a 3-week combination ganciclovir/foscarnet induction therapy (ganciclovir 5 mg/kg every 12 h; foscarnet 60 mg/kg every 8 h), followed by an alternating maintenance administration of both drugs every other day (ganciclovir 5 mg/kg, foscarnet 120 mg/kg) to reduce toxicity and resistance. This regimen was tolerated well and seemed to be more effective than ganciclovir alone in a patient with CMV encephalitis.
Peters
M
M
II. Medizinische Klinik, Universitätsklinikum Rudolf Virchow, Freie Universität Berlin.
Timm
U
U
Schürmann
D
D
Pohle
H D
HD
Ruf
B
B
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage*; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000150:complications / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D017245:Foscarnet; D015774:Ganciclovir / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008587:Meningitis, Viral / Q000188:drug therapy* / Q000382:microbiology; D010746:Phosphonoacetic Acid / Q000009:adverse effects / Q000031:analogs & derivatives*
D000998:Antiviral Agents; D017245:Foscarnet; D010746:Phosphonoacetic Acid; D015774:Ganciclovir