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Overview: treatment of cryptococcal meningitis
A M Sugar1, J J Stern, B Dupont
1Evans Memorial Department of Clinical Research, Boston University Medical Center, Massachusetts.
Reviews of Infectious Diseases
|March 1, 1990
Summary
New antifungal triazoles like fluconazole show promise for treating cryptococcal meningitis, offering better options than older drugs for immunocompromised patients. These agents are effective and well-tolerated, improving patient outcomes.
Area of Science:
- Mycology
- Infectious Diseases
- Pharmacology
Background:
- Cryptococcus neoformans infections, especially meningitis, cause significant mortality in immunocompromised individuals, notably those with AIDS.
- Amphotericin B, while improving prognosis, has limitations including modest efficacy, toxicity, and IV administration.
- Current therapies like amphotericin B and flucytosine have a ~30% failure rate; ketoconazole is ineffective.
Purpose of the Study:
- To evaluate the efficacy and tolerability of newer antifungal agents for cryptococcal meningitis.
- To identify improved treatment options beyond traditional therapies for this serious infection.
Main Methods:
- Review of accumulating evidence and preliminary clinical trials.
- Assessment of antifungal triazoles including fluconazole, itraconazole, and SCH 39304.
- Comparison of newer agents with established treatments like amphotericin B.
Main Results:
- Antifungal triazoles (fluconazole, itraconazole) show effectiveness and good tolerability in preliminary trials.
- These agents are suitable for both initial and maintenance therapy in cryptococcal meningitis patients, including those with AIDS.
- Ongoing large comparative trials are evaluating fluconazole against amphotericin B.
Conclusions:
- Antifungal triazoles represent a significant advancement in treating cryptococcal meningitis.
- Fluconazole and itraconazole offer a well-tolerated and effective alternative for managing this opportunistic infection.
- Further research through comparative trials will solidify the role of these agents in clinical practice.