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Initial Therapy for Acquired Immunodeficiency Syndrome-Associated Cryptococcosis With Fluconazole

Initial Therapy for Acquired Immunodeficiency Syndrome-Associated Cryptococcosis With Fluconazole Abstract Background: Published opinion has generally favored amphotericin B over fluconazole as initial therapy for acquired immunodeficiency syndrome—associated cryptococcosis, although data that support this recommendation are limited. Method: Retrospective review of 30 consecutive patients with acquired immunodeficiency syndrome— associated cryptococcosis seen at a single institution over a 1-year period and given fluconazole, 400 mg/d, as initial therapy. Results: No patient died within the first 30 days of therapy, and none of the 14 patients who died within 1 year had clinically detectable infection when last seen or at death. Pretreatment blood cultures were positive in 26 of 27 patients; cerebrospinal fluid cryptococcal antigen titer was greater than 1:1024 in 12 of 23 patients; and five of 30 patients presented with altered mental status. The median CD4 count at diagnosis was 0.042 ×109/L (42/μL). Eight of 25 patients who were followed up for more than 30 days relapsed, as evidenced by a positive culture; all relapses were successfully treated with fluconazole, either by reinstitution of therapy or by increase of dosage. Conclusion: This experience supports the use of fluconazole as initial therapy for acquired immunodeficiency syndrome—associated cryptococcosis.(Arch Intern Med. 1995;155:538-540) References 1. Armstrong D. Treatment of opportunistic fungal infections. Clin Infect Dis . 1993; 16:1-9.Crossref 2. Powderly WG. Cryptococcal meningitis and AIDS. Clin Infect Dis . 1993;17: 837-842.Crossref 3. Dismukes WE. Management of cryptococcosis. Clin Infect Dis . 1993;17( (suppl 2) ):S507-S512.Crossref 4. Saag ME, Powderly WG, Cloud GA, et al. Comparison of amphotericin B with fluconazole in the treatment of acute AIDS-associated cryptococcal meningitis. N Engl J Med . 1992;326:83-89.Crossref 5. Larsen RA, Leal MAE, Chan LS. Fluconazole compared with amphotericin B plus flucytosine for cryptococcal meningitis in AIDS. Ann Intern Med . 1990; 113:183-187.Crossref 6. McPherson K. The problem of examining accumulating data more than once. N Engl J Med . 1974;290:501-502.Crossref 7. Nightingale SD, Jockusch JD, Haslund I, Cal SX, Peterson DM, Loss SD. Logarithmic relation of the CD4 count to survival in patients with human immunodeficiency virus infection. Arch Intern Med . 1993;153:1313-1318.Crossref 8. Nightingale SD, Cal SX, Peterson DM, et al. Fluconazole prophylaxis of disseminated fungal infections in HIV-positive patients. AIDS . 1992;6:191-194.Crossref 9. Nightingale SD, Byrd LT, Southern PM, Jockusch JD, Cal SX, Wynne BA. Incidence of Mycobacterium avium-intracellulare (MAI) complex bacteremia in HIV-positive patients. J Infect Dis . 1992;165:1082-1085.Crossref 10. Bozette SA, Larsen RA, Chiu J, et al. A placebo-controlled trial of maintenance therapy with fluconazole after treatment of cryptococcal meningitis in the acquired immunodeficiency syndrome. N Engl J Med . 1991;324:580-584.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Initial Therapy for Acquired Immunodeficiency Syndrome-Associated Cryptococcosis With Fluconazole

Archives of Internal Medicine , Volume 155 (5) – Mar 13, 1995

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430050118013
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Published opinion has generally favored amphotericin B over fluconazole as initial therapy for acquired immunodeficiency syndrome—associated cryptococcosis, although data that support this recommendation are limited. Method: Retrospective review of 30 consecutive patients with acquired immunodeficiency syndrome— associated cryptococcosis seen at a single institution over a 1-year period and given fluconazole, 400 mg/d, as initial therapy. Results: No patient died within the first 30 days of therapy, and none of the 14 patients who died within 1 year had clinically detectable infection when last seen or at death. Pretreatment blood cultures were positive in 26 of 27 patients; cerebrospinal fluid cryptococcal antigen titer was greater than 1:1024 in 12 of 23 patients; and five of 30 patients presented with altered mental status. The median CD4 count at diagnosis was 0.042 ×109/L (42/μL). Eight of 25 patients who were followed up for more than 30 days relapsed, as evidenced by a positive culture; all relapses were successfully treated with fluconazole, either by reinstitution of therapy or by increase of dosage. Conclusion: This experience supports the use of fluconazole as initial therapy for acquired immunodeficiency syndrome—associated cryptococcosis.(Arch Intern Med. 1995;155:538-540) References 1. Armstrong D. Treatment of opportunistic fungal infections. Clin Infect Dis . 1993; 16:1-9.Crossref 2. Powderly WG. Cryptococcal meningitis and AIDS. Clin Infect Dis . 1993;17: 837-842.Crossref 3. Dismukes WE. Management of cryptococcosis. Clin Infect Dis . 1993;17( (suppl 2) ):S507-S512.Crossref 4. Saag ME, Powderly WG, Cloud GA, et al. Comparison of amphotericin B with fluconazole in the treatment of acute AIDS-associated cryptococcal meningitis. N Engl J Med . 1992;326:83-89.Crossref 5. Larsen RA, Leal MAE, Chan LS. Fluconazole compared with amphotericin B plus flucytosine for cryptococcal meningitis in AIDS. Ann Intern Med . 1990; 113:183-187.Crossref 6. McPherson K. The problem of examining accumulating data more than once. N Engl J Med . 1974;290:501-502.Crossref 7. Nightingale SD, Jockusch JD, Haslund I, Cal SX, Peterson DM, Loss SD. Logarithmic relation of the CD4 count to survival in patients with human immunodeficiency virus infection. Arch Intern Med . 1993;153:1313-1318.Crossref 8. Nightingale SD, Cal SX, Peterson DM, et al. Fluconazole prophylaxis of disseminated fungal infections in HIV-positive patients. AIDS . 1992;6:191-194.Crossref 9. Nightingale SD, Byrd LT, Southern PM, Jockusch JD, Cal SX, Wynne BA. Incidence of Mycobacterium avium-intracellulare (MAI) complex bacteremia in HIV-positive patients. J Infect Dis . 1992;165:1082-1085.Crossref 10. Bozette SA, Larsen RA, Chiu J, et al. A placebo-controlled trial of maintenance therapy with fluconazole after treatment of cryptococcal meningitis in the acquired immunodeficiency syndrome. N Engl J Med . 1991;324:580-584.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Mar 13, 1995

References