Combination antiviral therapy for ganciclovir-resistant cytomegalovirus infection in solid-organ transplant recipients.
The resistance of cytomegalovirus (CMV) to ganciclovir is a factor in therapeutic failure and disease progression. The clinical significance of such resistance in solid-organ transplantation has not been completely established. Six patients who developed persistent infection due to ganciclovir-resistant CMV were treated with a combination of ganciclovir (50% of the therapeutic dose) and a daily dose of intravenous foscarnet that gradually increased to a maximum of 125 mg/kg. All patients responded clinically within 72-96 hours. Magnesium depletion occurred in all patients. No clinical or laboratory relapses have been observed in 6-30 months of follow-up. Gradually increasing doses of foscarnet combined with half-dose regimens of ganciclovir are safe and can be beneficial in organ transplant recipients with ganciclovir-resistant CMV infection. Larger studies are needed to identify the patients who are most likely to benefit from this regimen.
Mylonakis
Eleftherios
E
Infectious Disease Division, Massachusetts General Hospital, Boston, MA, 02114, USA.
Kallas
Wendy M
WM
Fishman
Jay A
JA
D000328:Adult; D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000187:drug effects; D003586:Cytomegalovirus Infections / Q000188:drug therapy*; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D005260:Female; D017245:Foscarnet / Q000627:therapeutic use*; D015774:Ganciclovir / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019737:Transplants; D016896:Treatment Outcome
D000998:Antiviral Agents; D017245:Foscarnet; D015774:Ganciclovir