Ganciclovir

CMV retinitis (immunocompromised patients): Manufacturer's labeling: Induction therapy: IV: 5 mg/kg/dose every 12 hours for 14 to 21 days followed by maintenance therapy Maintenance therapy: IV: 5 mg/kg/dose once daily for 7 days/week or 6 mg/kg/dose once daily for 5 days/week Alternate dosing (HHS [OI adult 2017]): Peripheral lesions (alternative agent): IV: Induction: 5 mg/kg/dose every 12 hours for 14 to 21 days followed by chronic maintenance (secondary prophylaxis) Immediate sight-threatening lesions (adjacent to the optic nerve or fovea): Intravitreal injection (off-label route): Induction therapy: 2 mg of an extemporaneously prepared solution administered as intravitreal injections for 1 to 4 doses over a period of 7 to 10 days; administer with a concomitant systemically administered agent (oral valganciclovir preferred). CMV disease prophylaxis in transplant patients: IV: Manufacturer's labeling: Induction therapy: 5 mg/kg/dose every 12 hours for 7 to 14 days Maintenance therapy: 5 mg/kg/dose once daily for 7 days/week or 6 mg/kg/dose once daily for 5 days/week; duration is dependent on clinical condition and degree of immunosuppression Alternate dosing: Hematopoietic cell transplant recipients (allogeneic): 5 mg/kg/dose every 12 hours for 5 to 7 days, then 5 mg/kg/dose every 24 hours until day 100 post-transplant (Tomblyn 2009). Solid organ transplant recipients: 5 mg/kg/dose every 24 hours; duration of prophylaxis is dependent on type of transplant, as well as donor and recipient CMV serostatus (Kotton 2013). CMV disease, preemptive therapy (hematopoietic cell transplant recipients) (off-label use) (Tomblyn 2009): IV: 5 mg/kg/dose every 12 hours for 7 days (autologous transplant) or 7 to 14 days (allogenic transplant), then 5 mg/kg/dose every 24 hours for 1 to 2 weeks or until the indicator test is negative (minimum total induction and maintenance treatment is 2 weeks when 14 days of twice daily is used and 3 weeks when a 7-day induction course is used). >100 days post-transplant: 5 mg/kg/dose every 12 hours for 7 to 14 days, then 5 mg/kg/dose every 24 hours for 1 to 2 weeks or until the indicator test is negative. CMV disease, treatment (solid organ transplant recipients) (off-label use): IV: 5 mg/kg/dose every 12 hours until 1 or 2 consecutive undetectable CMV viral load samples are obtained (minimum treatment course: 2 weeks) (Kotton 2013). UL97 mutation for 10 mg/kg/dose every 12 hours (Kotton 2013). Ganciclovir-resistant strains: 5 mg/kg/dose every 24 hours in combination with daily foscarnet and monthly CMV hyperimmunoglobulin (Mylonakis 2002). CMV esophagitis or colitis in HIV-infected patients (off-label use): IV: 5 mg/kg/dose every 12 hours, then change to oral valganciclovir therapy once oral therapy is tolerated; total duration of therapy: 21 to 42 days or until symptom resolution (HHS [OI adult 2017]). CMV neurological disease in HIV-infected patients (off-label use): IV: 5 mg/kg/dose every 12 hours plus foscarnet until symp