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Current guidelines for the treatment of AIDS-related cryptococcal meningitis recommend amphotericin B (AmB) at a daily dose of 0.7 to 1.0 mg/kg, along with flucytosine. Many clinicians today use the higher dose of AmB (1 mg/kg), but it has never been compared against the “standard dose” (0.7 mg/kg) in a head-to-head randomized, prospective trial. Now, researchers have performed such a trial (albeit nonblinded) among 64 AIDS patients in South Africa with cryptococcal meningitis.
All study participants were cerebrospinal fluid (CSF) culture–positive; no one was taking antiretroviral therapy (ART). Thirteen percent had altered mental status, which has been shown in prior studies to be the most important predictor of poor prognosis. Patients rec…