Dose banding of intravenous ganciclovir: Banding scheme proposal and audit of toxicity and efficiency

2021 ◽  
Author(s):  
Montserrat Rodriguez‐Reyes ◽  
Carmen López‐Cabezas ◽  
Elena Calvo‐Cidoncha ◽  
Dolors Soy‐Muner
Keyword(s):  
Intravenous Ganciclovir

scholarly journals Preemptive ganciclovir for mechanically ventilated patients with cytomegalovirus reactivation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Laurent Papazian ◽  
◽  
Samir Jaber ◽  
Sami Hraiech ◽  
Karine Baumstarck ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Double Blind ◽  
Intravenous Ganciclovir ◽  
Subdistribution Hazard ◽  
Mechanically Ventilated ◽  
Cytomegalovirus Reactivation ◽  
Secondary Outcomes ◽  
To Receive ◽  
Cmv Reactivation

Abstract Background The effect of cytomegalovirus (CMV) reactivation on the length of mechanical ventilation and mortality in immunocompetent ICU patients requiring invasive mechanical ventilation remains controversial. The main objective of this study was to determine whether preemptive intravenous ganciclovir increases the number of ventilator-free days in patients with CMV blood reactivation. Methods This double-blind, placebo-controlled, randomized clinical trial involved 19 ICUs in France. Seventy-six adults ≥ 18 years old who had been mechanically ventilated for at least 96 h, expected to remain on mechanical ventilation for ≥ 48 h, and exhibited reactivation of CMV in blood were enrolled between February 5th, 2014, and January 23rd, 2019. Participants were randomized to receive ganciclovir 5 mg/kg bid for 14 days (n = 39) or a matching placebo (n = 37). Results The primary endpoint was ventilator-free days from randomization to day 60. Prespecified secondary outcomes included day 60 mortality. The trial was stopped for futility based on the results of an interim analysis by the DSMB. The subdistribution hazard ratio for being alive and weaned from mechanical ventilation at day 60 for patients receiving ganciclovir (N = 39) compared with control patients (N = 37) was 1.14 (95% CI from 0.63 to 2.06; P = 0.66). The median [IQR] numbers of ventilator-free days for ganciclovir-treated patients and controls were 10 [0–51] and 0 [0–43] days, respectively (P = 0.46). Mortality at day 60 was 41% in patients in the ganciclovir group and 43% in the placebo group (P = .845). Creatinine levels and blood cells counts did not differ significantly between the two groups. Conclusions In patients mechanically ventilated for ≥ 96 h with CMV reactivation in blood, preemptive ganciclovir did not improve the outcome.

CMV pneumonitis in a patient with Crohn’s disease taking azathioprine

2021 ◽  
Vol 14 (4) ◽  
pp. e241256
Author(s):  
Timothy Zef Hawthorne ◽  
Rachel Shellien ◽  
Lucy Chambers ◽  
Graham Devereux
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Low Dose ◽  
Antiviral Treatment ◽  
Cmv Infection ◽  
Rare Presentation ◽  
Intravenous Ganciclovir ◽  
Increased Risk ◽  
Oral Valganciclovir

This case report discusses the rare presentation of cytomegalovirus (CMV) pneumonitis in a young patient with moderately severe Crohn’s disease managed with low dose azathioprine. CMV pneumonitis was initially suspected on CT chest images and confirmed by PCR for CMV. She was treated with intravenous ganciclovir and later stepped down to oral valganciclovir. Although this patient had a prolonged and complicated hospital admission, a good clinical outcome was achieved. CMV infection was raised as an early differential and antiviral treatment was started without delay. This case study, therefore, makes the case for increased awareness of the possibility of, and recognition of CMV pneumonitis among healthcare professionals as a way of preventing significant morbidity and mortality. It also raises awareness of checking for slow metabolisers of azathioprine before initiation to look for individuals who may be at increased risk of azathioprine’s adverse effects.

scholarly journals A rare case of cytomegalovirus presentation in a hemodialysis patient

2017 ◽  
Vol 4 (3) ◽  
pp. 79
Author(s):  
Liesbeth De Waele ◽  
Katrien Wierckx ◽  
Anne-Marie Bogaert
Keyword(s):  
Terminal Ileum ◽  
Hemodynamic Instability ◽  
Cmv Infection ◽  
Intravenous Ganciclovir ◽  
Diffuse Abdominal Pain ◽  
Rare Manifestation ◽  
End Stage ◽  
Gastro Intestinal Tract ◽  
Cmv Disease ◽  
Substantial Morbidity

Background: Cytomegalovirus (CMV) infection is a common viral infection in humans with a diverse manifestation, mostly dependent on the host. CMV infection in the immunocompetent host is generally asymptomatic or may present as a mononucleosis syndrome. Infection in immunocompromised patients cause substantial morbidity and mortality.Case representation: We report a rare manifestation of a CMV infection in a 87-year-old male with end-stage renal failure with dialysis dependency and diabetes who presents with diffuse abdominal pain and nausea. Further assessment with a CT scan of the abdomen showed a thickening of the wall of the preterminal ileum, suggestive of focal enteritis. Ileocolonoscopy showed a partial circular ulcerated mucosa of the preterminal ileum, biopsies showed ulcerations, etiology was unknown. A few days later he develops melena and anemia of 7.2 g/dl. Further exploration with gastroscopy was normal. A new colonoscopy showed no abnormalities; however the terminal ileum could not be visualized. An urgent laparotomy was performed because of hemodynamic instability and showed an ulcus of 7 cm with a thickened terminal ileum. An enterectomy of the inflammated part of the ileum was performed. Histopathology of the ulceration showed the presence of CMV inclusions in the vascular endothelium of the capillaires of the ileal segment. Serologic examination showed nonreactive CMV IgM antibodies and IgG antibodies were positive. PCR CMV showed 300 copies/ml (whole blood). Treatment with intravenous ganciclovir was started with good clinical and biochemical response.Conclusions: In the differential diagnosis CMV disease should be considered in any ulceration in the gastro-intestinal tract in the immunocompromised patient.

scholarly journals Synchronous cytomegalovirus infection in a newly diagnosed ulcerative colitis patient

2017 ◽  
Vol 8 (1) ◽  
Author(s):  
Jin Yu Chieng ◽  
Yasotha Sugumaran ◽  
Sellymiah Adzman ◽  
Pan Yan
Keyword(s):  
Ulcerative Colitis ◽  
Medical Illness ◽  
C Reactive Protein ◽  
Colitis Patient ◽  
Intravenous Ganciclovir ◽  
Reactive Protein ◽  
Chronic Medical Illness ◽  
History Of ◽  
Cmv Colitis

A 61-year-old Punjabi female patient presented with six months history of mild abdominal discomfort with bloody diarrhea. She did not have underlying chronic medical illness; she neither took steroid nor immunosuppressant. She was found anemic, thrombocytosis, and elevated C-reactive protein. Colonoscopy showed moderate left sided colitis, with histopathology evidence of ulcerative colitis (UC) with cytomegalovirus (CMV) infection. Her serum anti-CMV IgM antibody was detected. She was treated with intravenous ganciclovir, together with 5-ASA and tapering dose of steroid. Anemia was corrected. Subsequent clinic reviews and follow up endoscopies showed dramatically improvement. CMV colitis should be considered for the patients presenting with moderate to severe UC. Early prescription of antiviral would be beneficial in the treatment of flare of UC.

Valganciclovir Dosing for Cytomegalovirus Prophylaxis in Solid-organ Transplant Recipients on Continuous Veno-venous Hemodialysis

2020 ◽  
Author(s):  
Andrew S Jarrell ◽  
Jessica R Crow ◽  
Sara E Strout ◽  
Rachel M Kruer ◽  
Lindsey P Toman ◽  
...  
Keyword(s):  
Organ Transplant ◽  
Population Based ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Open Label ◽  
Intravenous Ganciclovir ◽  
Trough Concentrations ◽  
Average Body Mass ◽  
Bilateral Lung ◽  
Cmv Prophylaxis

Abstract Background Optimal valganciclovir dosing for cytomegalovirus (CMV) prophylaxis in solid-organ transplant (SOT) patients on continuous veno-venous hemodialysis (CVVHD) is not known. Ganciclovir trough concentrations ≥0.60 μg/mL have been suggested for CMV prophylaxis. This study was conducted to determine if valganciclovir 450 mg enterally every 24 hours achieves ganciclovir trough concentrations ≥0.60 μg/mL in patients on CVVHD. Methods This single-center, prospective, open-label, pharmacokinetic study included adult SOT patients admitted to an intensive care unit from March 2018 to June 2019 on CVVHD. All patients were receiving valganciclovir 450 mg enterally every 24 hours for CMV prophylaxis prior to enrollment. Each patient had a peak and trough sample drawn at steady state. Results Ten SOT patients were included in the study (6 liver, 1 simultaneous liver-kidney, 2 bilateral lung, 1 heart). The mean ± SD age was 51.8 ± 14.0 years, and average body mass index was 27 ± 6.9 kg/m2. Ganciclovir trough concentrations ranged from 0.31 to 3.16 μg/mL, and 80% of participants have trough concentrations ≥0.60 μg/mL. No patients had documented neutropenia while on valganciclovir and CVVHD; 60% of patients had significant thrombocytopenia. Conclusions Valganciclovir 450 mg enterally every 24 hours achieved ganciclovir trough concentrations ≥0.60 μg/mL in most patients on CVVHD, similar to those reported with intravenous ganciclovir for prophylaxis in this population. Based on these data, valganciclovir may require dosing every 24 hours to achieve concentrations equivalent to ganciclovir. Neutropenia did not occur in the study period. Thrombocytopenia was common and likely multifactorial.

Home care reimbursement for intravenous ganciclovir therapy

1996 ◽  
Vol 53 (2) ◽  
pp. 161-163 ◽  
Author(s):  
Essy Mozaffari ◽  
Sean D. Sullivan
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Home Care ◽  
Home Health Care ◽  
Home Health ◽  
Fee For Service ◽  
Geographic Variations ◽  
Intravenous Ganciclovir ◽  
Ganciclovir Therapy ◽  
Nursing Services

Variability in reimbursement for home i.v. ganciclovir therapy among three types of payers was investigated. A survey was developed to estimate reimbursement for drug and medical supplies and nursing services associated with preparing i.v. ganciclovir and administering it to persons with cytomegalovirus (CMV)-associated retinitis in the home care setting. The questionnaire was mailed to 45 home health care agencies and 11 nursing agencies. Of the 56 surveys mailed, 26 (46%) were returned and considered usable. Of the 26 respondents, 22 were home health care companies, 4 were nursing ageiicies, 22 served patients covered by managed care or state assistance that reimbursed on a per diem trasis, and 9 did not provide care to fee-for-service patients. The mean total daily-reimbursement rate (for ganciclovir, supplies, and nursing services) from managed care per diem plans was $137.69 per patient, compared with $I29.18 from fee-for-service plans and $72.68 from state assistance per diem plans. The dissimilarity may have been due to geographic variations in reimbursement and different mechanisms of reimbursement. Providers of home i.v. ganciclovir therapy for persons with CMV retinitis received the highest tnean total daily reimbursement from managed care per diem plans, followed by fee-for-service plans and state assistance per diem plans.

scholarly journals Small bowel perforation secondary to CMV-positive terminal ileitis postrenal transplant

2019 ◽  
Vol 12 (11) ◽  
pp. e231662 ◽  
Author(s):  
Kosuke Kato ◽  
Michelle Cooper
Keyword(s):  
Small Bowel ◽  
Rare Complication ◽  
Bowel Perforation ◽  
Lower Abdominal Pain ◽  
Right Hemicolectomy ◽  
Small Bowel Perforation ◽  
Cmv Infection ◽  
Terminal Ileitis ◽  
Intravenous Ganciclovir ◽  
Cmv Disease

Cytomegalovirus (CMV) infection of the gastrointestinal tract is common in immunosuppressed patients; however, small bowel perforation from tissue-invasive CMV disease after many years of immunosuppressive therapy is a rare complication requiring timely medical and surgical intervention. We report a case of a postrenal transplant patient who presented to the emergency department with severe lower abdominal pain with CT of the abdomen/pelvis revealing a small bowel perforation. He underwent an emergent laparoscopic right hemicolectomy, and his histopathology of the terminal ileum was positive for CMV disease. He was successfully treated with intravenous ganciclovir postoperatively. We discuss the pathophysiology, histopathological features and treatment of CMV infection.

scholarly journals Cytomegalovirus Retinitis in an ALL Child during Maintenance Therapy Treated Successfully with Intravenous Ganciclovir

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Hande Celiker ◽  
Ayse Karaaslan ◽  
Eda Kepenekli Kadayifci ◽  
Serkan Atici ◽  
Ahmet Soysal ◽  
...  
Keyword(s):  
Anterior Chamber ◽  
Lymphoblastic Leukemia ◽  
Maintenance Phase ◽  
Cytomegalovirus Retinitis ◽  
Intravenous Ganciclovir ◽  
Hematopoietic Stem ◽  
Normal Limits ◽  
Retinal Examination ◽  
Oral Valganciclovir ◽  
The Right

Purpose.In here we described cytomegalovirus retinitis (CMVR) in 12-year-old male patient with acute lymphoblastic leukemia (ALL) who was on maintenance phase therapy.Methods.He was referred to our clinic for seeing of spots with the right eye for 3 days. At presentation, his best corrected visual acuity was 20/20 in the right eye and 20/20 in the left eye. Slit-lamp biomicroscopic examination of the anterior chamber of the left eye was within normal limits, whereas we observed 3+ anterior chamber cellular reaction in the right eye. On retinal examination, we found active retinitis lesions (cream-colored lesions associated with hemorrhages) and perivascular cuffing in the retinal periphery in the right eye. Left eye was normal.Results.On the basis of clinical picture, we made the diagnosis of CMVR in the right eye. Vitreous aspiration was performed and 23096 copies/mL of CMV DNA was detected by polymerase chain reaction (PCR) technique. The patient was successfully treated with intravenous ganciclovir for two weeks and discharged with oral valganciclovir prophylaxis.Conclusion.CMVR should be in mind in children with ALL on maintenance phase therapy even in those without hematopoietic stem cell transplantation. These patients can be treated successfully by intravenous ganciclovir alone.

Sign in / Sign up

Export Citation Format

Share Document