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Antifungal therapy for treatment of cryptococcal meningitis
1Laboratory of Medical Mycology, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China.
Objective:
To compare the curative effects of three different antifungal regimens in the treatment of cryptococcal meningitis.
Methods:
Twenty-two patients were divided into 3 groups: Group I was given intravenous amphotericin B alone or combination with flucytosine therapy. Group II received intravenous fluconazole alone or combination with flucytosine. The treatment of Group III was divided into two steps, where the patients received intrathecal amphotericin B plus intravenous amphotericin B with or without intravenous fluconazole until the mycological culture of cerebrospinal fluid (CSF) turned negative, followed by oral fluconazole or itraconazole as maintenance therapy until direct microscopic examination of CSF showed negative once a week for three consecutive weeks.
Results:
Of the twenty-two patients, 17 (77.3%) were cured, 2 (9.1%) improved, 3 (13.6%) died, and one (4.5%) relapsed. Of the 8 patients in Group I, 5 were cured, 2 improved, one died and one relapsed; Of the 4 patients in Group II, 2 were cured, and 2 died; All the 10 patients in Group III were cured without any recurrence.
Conclusion:
The two-step therapeutic regimen may be suited to the treatment of cryptococcal meningitis.