High-Dose FLU + 5FC for Cryptococcal Meningitis?

Among HIV-infected patients with cryptococcal meningitis, fungal CSF clearance was more rapid with fluconazole plus flucytosine than with fluconazole alone.

In resource-limited areas, cryptococcal meningitis (CM) is a leading cause of HIV-associated death. Intravenous amphotericin B (AmB) plus oral 5-flucytosine (5FC) is considered the standard therapy, but cost and need for intravenous administration preclude widespread use in sub-Saharan Africa. Studies involving fluconazole (FLU) alone have shown some efficacy, and limited data suggest that adding 5FC to FLU might improve outcome.

In an open-label study conducted in Malawi, 44 adults with HIV infection and first-episode CM who were not receiving antiretroviral therapy were randomized to receive FLU (1200 mg daily) either alone or together with 5FC (100 mg/kg/day) for 14 days. Quantitative cerebrospinal fluid (CSF) fungal cultures of samples o…

Reviewing Author

Neil M. Ampel, MD

Disclosures

Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesCoccidioidomycosis Study Group (Past President, Secretary, Treasurer)

Neil M. Ampel, MD

Disclosures

Editorial BoardsUpToDate

Leadership Positions in Professional SocietiesCoccidioidomycosis Study Group (Past President, Secretary, Treasurer)