Which medications are used for the treatment of cytomegalovirus (CMV) pneumonia?

Updated: Mar 24, 2021
  • Author: Zab Mosenifar, MD, FACP, FCCP; Chief Editor: John J Oppenheimer, MD  more...
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Answer

The primary treatment for acute cytomegalovirus (CMV) pneumonia in the immunocompromised patient (both HSCT and solid organ transplant [SOT] recipients) is ganciclovir (5 mg/kg IV 12h for 14-21 d, followed by valganciclovir 900 mg PO qd for suppression). Ganciclovir prevents viral DNA replication by inhibiting the enzyme DNA polymerase. [101]

High-dose intravenous immunoglobulin (CMV immunoglobulin or IVIG) has been used successfully in conjunction with ganciclovir for the treatment of CMV pneumonia, decreasing the mortality rate to 0-47%. Combination therapy is based on the premise that lung injury is not solely due to direct damage by the virus but is a result of virally induced immunological reaction. In lung transplant recipients, ganciclovir with CMV immunoglobulin or IVIG has been associated with increased survival. [102]

Foscarnet sodium, an inhibitor of viral DNA polymerase and reverse transcriptase, is an alternative drug for use in ganciclovir-resistant CMV pneumonia. The combination of foscarnet with ganciclovir may provide antiviral synergy, but it requires careful monitoring. [103]

Cidofovir represents a third option, but scant data exist regarding its use in CMV pneumonia.


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