Recent advances in the management of cryptococcal meningitis in patients with AIDS

Powderly, W. G.

Author address: 

Powderly, WG, CLIN TRIALS UNIT,4511 FOREST PK,SUITE 304,ST LOUIS,MO 63108

Abstract: 

The optimum regimen for the treatment of cryptococcal meningitis in patients with AIDS is still not totally clear. The triazoles fluconazole and itraconazole are associated with response rates of 50%-60%. Amphotericin B appears to be associated with a more rapid clearance of organisms, and there are some data suggesting that initial therapy with amphotericin B is preferable to that with triazoles; however, this finding has not been definitively shown in large comparative trials. Results of a recently completed large trial suggested that initial treatment with amphotericin B followed by triazole therapy is associated with an acute mortality rate (similar to 6%) that is substantially less than that in previous studies. Relapse is common (20%-60% of cases) if the patient does not receive chronic suppressive therapy. The drug of choice for maintenance therapy is fluconazole (200 mg/d). A recent trial showed that fluconazole was superior to itraconazole (200 mg/d) as suppressive therapy. Prophylactic use of fluconazole (200 mg/d) significantly decreases the incidence of cryptococcosis and mucosal candidiasis, especially in patients with CD4 cell counts of
1995

abstract No: 

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Full conference title: 

Focus on Fungal Infections 5 Meeting
    • Focus on Fungal Infection 5 (1995)