title: Activity of 9-[2-hydroxy-1-(hydroxymethyl)ethoxymethyl]guanine in the treatment of cytomegalovirus pneumonia.
abstract: Ten marrow transplant recipients with biopsy-proven cytomegalovirus pneumonia were treated with the acyclic nucleoside analog 9-[2-hydroxy-1-(hydroxymethyl) ethoxymethyl]guanine (BW B759U). Viruria and viremia ceased after 4 days of treatment in all patients with cultures initially positive from these sites. Cytomegalovirus was eliminated from respiratory secretions after a median of 8 days. Despite this antiviral effect, only one patient survived the pneumonia. Quantitative cultures of lung tissue before and after treatment confirmed that therapy with BW B759U was associated with substantial antiviral activity, with a mean decrease in viral titers of more than 99.99% after treatment. Neutropenia developed in three patients when mean peak and trough plasma levels exceeded 50 and 10 mu mol/L, respectively, but no other toxicity was seen. BW B759U is the first antiviral agent showing consistent activity against cytomegalovirus in vivo, and it should be evaluated in the earlier management of cytomegalovirus infections after marrow transplantation and in serious cytomegalovirus infections in other immunocompromised patients.
authors.forename: D H
authors.initials: DH
authors.lastname: Shepp
authors.forename: P S
authors.initials: PS
authors.lastname: Dandliker
authors.forename: P
authors.initials: P
authors.lastname: de Miranda
authors.forename: T C
authors.initials: TC
authors.lastname: Burnette
authors.forename: D M
authors.initials: DM
authors.lastname: Cederberg
authors.forename: L E
authors.initials: LE
authors.lastname: Kirk
authors.forename: J D
authors.initials: JD
authors.lastname: Meyers
mesh_terms: D000212:Acyclovir / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000378:metabolism / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects / Q000378:metabolism / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D015774:Ganciclovir; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology; D008168:Lung / Q000382:microbiology; D008297:Male; D009503:Neutropenia / Q000139:chemically induced; D011024:Pneumonia, Viral / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D011183:Postoperative Complications / Q000188:drug therapy; D014018:Tissue Distribution
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir; D000212:Acyclovir