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Antimicrobials during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Ganciclovir is a nucleoside analog similar to acyclovir. It has been shown readily to cross the human placenta (Gilstrap et al., 1994; Henderson et al., 1993). Ganciclovir is more toxic than acyclovir, and there is no information regarding its use during pregnancy.
Cytomegalovirus
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Ganciclovir inhibits viral DNA polymerase, and has been used successfully in adults, especially immunocompromised (AIDS, transplant, etc.) patients. There are no randomized controlled trials evaluating fetal therapy with ganciclovir. Ganciclovir administration into the umbilical vein and anti-CMV IgG injections into the fetal abdominal cavity have been reported in case reports [24], as has ganciclovir given orally to a pregnant woman with CMV DNA in the AF, but the evaluation of the prognosis is not well established; case reports have shown no teratogenicity of ganciclovir given in the early stages of pregnancy [54]. A small pediatric trial demonstrated reduction of hearing loss in neonates with proven congenital CMV infection with CNS involvement when treatment was begun within one month of birth [55].
Anti-Infective Agents
Published in Radhwan Nidal Al-Zidan, Drugs in Pregnancy, 2020
Risk Summary: Due to the carcinogenic and mutagenic effects of Ganciclovir in animals and the potential for fetal toxicity, some experts recommend that ganciclovir should only be used during pregnancy for immunocompromised patients with major CMV infections, such as retinitis or for life-threatening disease.
Prognostic Factors of Cytomegalovirus Infection Associated Retinitis in HIV-Negative Patients: A Retrospective Cohort Study
Published in Ocular Immunology and Inflammation, 2021
Zhuyun Qian, Xu Chen, Yong Tao, Wensheng Li, Wei Gu
The side effects of systemic ganciclovir include renal failure, neutropenia, and thrombocytopenia.9 In this study of CMVR, all included patients were HIV negative and were in the states of immunosuppression. No systemic ganciclovir was applied in fear of the aggravation of neutropenia and thrombocytopenia. We previously proved the safety and efficacy of 1 mg IV of ganciclovir in HIV-negative patients suffering from CMVR.10 Recently, we changed the treatment protocol by increasing the IV dosage to an initial 6 mg of ganciclovir, followed by 4.5 mg and 3 mg of ganciclovir. The advantage of this treatment protocol is that the mean total number of injections is less than that in previous studies. The safety of this high dosage was also proved during the follow-up that no drug toxicity reaction was observed.11 In the present study, this treatment protocol was continuously applied. The mean number of IVs for each eye was 5.01 ± 2.38, which was also less than the data reported by Jeons et al. and Lu et al.,3,4 further confirming our previous conclusion.
Utility of Ultra-Widefield Retinal Imaging in the Follow-up and Management of Patients with Cytomegalovirus Retinitis
Published in Ocular Immunology and Inflammation, 2020
John P. Liscombe-Sepúlveda, Carmen Alba-Linero, Víctor Llorenç-Belles, Alfredo Adán-Civera
A 77-year-old female with history of autoimmune hemolytic anemia under treatment with Azathioprine and a 2-week bilateral vision loss. UWF retinal images of the LE revealed vitritis, disc pallor, diffuse intraretinal hemorrhages, and a superior peripheral granular lesion, suggesting a probable infectious vasculitis in association with two areas of probable choroidal affection (Figure 4a). FAF revealed a coincident superior heterogeneous area with hyperautofluorescent margins and two homogeneous hyperautofluorescent lesions, respectively (Figure 4b). A complete infectious study and aqueous humor polymerase chain reaction (PCR) for herpes viridae family were performed giving a positive result for CMV. An intravenous Ganciclovir treatment was initiated. Even though choroidal lesions remained under study, retinal peripheral lesions seemed to have an adequate response to treatment in the following weeks with an apparent decrease in activity on the leading edges (Figure 4c), leaving a well-delimitated hypoautofluorescent atrophic retinal area (Figure 4d).
Clinical Evaluation of Intravitreal Injection of Ganciclovir in Refractory Corneal Endotheliitis
Published in Ocular Immunology and Inflammation, 2020
Ting Yu, Rong-Mei Peng, Ge-Ge Xiao, Li-Na Feng, Jing Hong
Within virus-infected cells, ganciclovir (GCV) is directly incorporated into viral deoxyribonucleic acid (DNA) and competitively inhibits viral DNA polymerase, resulting in the arrest of viral DNA replication and the rapid induction of virus-infected cell apoptosis. Consequently, GCV does not affect the DNA of healthy human cells, minimizing host toxicity.9–11 It is critical to maintain aqueous GCV concentrations to control viral infection in endotheliitis. Topical and systemic application of GCV have been suggested to suppress the infection.9,11–14 Previous results have, however, been variable, with failures observed in studies using each treatment strategy. In these cases, it is possible that topical and systemic GCV had difficulty penetrating across the corneal and blood-ocular barriers into the aqueous humor, resulting in lower-than-effective drug concentrations.15,16 However, long-term use of topical and systemic GCV is associated with toxic keratopathy, pancytopenia, and hepatorenal dysfunction.10,17,18