Improving Treatment Regimens for Cryptococcal Meningitis in Africa

Cryptococcal meningitis continues to be a common opportunistic infection with high mortality in persons with AIDS. International treatment recommendations are 2 weeks of amphotericin B plus flucytosine. However, in most of the world, neither amphotericin B nor flucytosine is available or affordable; thus, fluconazole monotherapy is the most common treatment, but the associated mortality is high (50% to 60% at 10 weeks).

To test alternative regimens, researchers randomized 721 HIV-positive patients with cryptococcal meningitis seen at nine African centers to one of three induction regimens: oral fluconazole 1200 mg/day plus flucytosine 100 mg/kg/day for 2 weeks; 1 week of intravenous amphotericin B 1 mg/kg/day; or 2 weeks of IV amphotericin B…