LETTER
Acyclovir and Ganciclovir in Cytomegalovirus
Gary B. Moss, MD
1 September 1994 | Volume 121 Issue 5 | Page 385
TO THE EDITOR:
In their study, Singh and colleagues [1] propose "to assess the efficacy of high-dose oral acyclovir compared with preemptive, short-course ganciclovir therapy ... to prevent CMV [cytomegalovirus] disease in live transplant patients." Although their data strongly support the efficacy of ganciclovir over acyclovir in these patients, they do not directly compare these two medications.
Each patient was randomly assigned to receive either high-dose oral acyclovir or no prophylaxis. If patients in either group later developed evidence of active CMV infection, they received a short course of gancyclovir to prevent progression of disease.
Because all patients in both groups receive ganciclovir if they exhibit signs of CMV infection, short-course ganciclovir therapy was not the subject of the study. Instead, the randomized trial compared the efficacy of oral acyclovir prophylaxis with that of no prophylaxis. Although this phase of the study was not double-blinded, it strongly suggests that acyclovir is not an effective prophylaxis against CMV in patients receiving liver transplantation. In addition, ganciclovir appeared to be an effective treatment against CMV infection and disease.
1. Singh N, Yu VL, Mieles L, Wagener MM, Miner RC, Gayowski T. High-dose acyclovir compared with short-course preemptive ganciclovir therapy to prevent cytomegalorvirus disease in liver transplant recipients. A randomized trial. Ann Intern Med. 1994; 120:375-81.
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