Ganciclovir is a
nucleoside analogue with
antiviral activity in vitro against members of the herpes group and some other DNA viruses. It has demonstrated efficacy against human
cytomegalovirus infections and should be considered a first-line
therapy in the treatment of life- or sight-threatening
cytomegalovirus infection in immunocompromised patients. Clinical efficacy varies with the underlying aetiology of immunocompromise and the site of disease, and prompt diagnosis and early treatment initiation appear to improve the response. In patients with cytomegalovirus
pneumonia, particularly bone marrow transplant recipients, concomitant administration of cytomegalovirus
immune globulin may significantly improve clinical outcome. Maintenance
therapy to prevent recurrence is usually required by bone marrow transplant recipients until the recovery of adequate immune function, whereas
AIDS patients may require indefinite
ganciclovir maintenance
therapy to prevent
disease progression, as
ganciclovir (like other
antivirals) does not eradicate latent
viral infection. Haematological effects occur relatively frequently during
ganciclovir administration but are usually reversible.
Ganciclovir has not been directly compared with other
antiviral drugs because of the absence until recently of other effective treatments. However, comparative studies with
foscarnet, particularly in
cytomegalovirus retinitis, will be of considerable interest. Thus,
ganciclovir represents a major advance in the
therapy of
severe cytomegalovirus infections in immunocompromised patients. Comparative studies, and investigation of ways of reducing toxicity (intravitreal administration; concomitant use of stimulants of haematopoiesis; use in conjunction with other
antivirals with differing mechanisms of action), may further expand its eventual role.