For Cryptococcal Meningitis, Is More Fluconazole Better?

Among HIV-infected patients in Uganda, cryptococcal infection was cleared more rapidly with 1200 mg daily than with 800 mg daily.

In many parts of sub-Saharan Africa, cryptococcal meningitis (CM) is a common opportunistic infection among HIV-infected individuals. Facilities and resources to provide intravenous amphotericin B are often lacking in these areas, and oral fluconazole has been prescribed instead. Fluconazole doses of 200 to 400 mg daily are only fungistatic during the first 2 weeks of treatment and may predispose patients to the development of resistance. Might higher doses be more effective?

To find out, researchers performed a cohort study in southwestern Uganda among HIV-infected, antiretroviral therapy–naive adults with first-episode CM. The first 30 patients received 800 mg of fluconazole daily, and the next 30 received 1200 mg daily. Quantitative funga…

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)