Combination Therapy for Cryptococcal Meningitis

The probability of survival was significantly higher with amphotericin B plus flucytosine than with amphotericin B alone.

Since 2010, the Infectious Diseases Society of America has recommended combination antifungal therapy — amphotericin B plus flucytosine — for the induction treatment of cryptococcal meningitis. Despite this recommendation, no previous studies have demonstrated a survival benefit with such therapy. Now, investigators have conducted a three-group, open-label trial of combination therapy involving 299 HIV-infected patients aged >14 years who were treated for cryptococcal meningitis between April 2004 and September 2010 at a medical center in Vietnam.

The patients were randomized to receive one of three antifungal regimens:

Intravenous amphotericin B, 1 mg/kg daily for 4 weeks, followed by oral fluconazole, 400 mg daily for 6 weeks (Group 1)
Intra…

Reviewing Author

Larry M. Baddour, MD

Disclosures

RoyaltiesUpToDate, Inc. (Authorship duties)

Larry M. Baddour, MD

Disclosures

RoyaltiesUpToDate, Inc. (Authorship duties)