Opportunistic Infections & Other Complications: Cryptococcal Meningitis


Opportunistic Infections & Other Complications: Cryptococcal Meningitis

Seattle Treatment Education Project (STEP) Perspective, Vol. 5, No. 2 - July 1993 * 127 Broadway E. Ste 200 Seattle, WA 98102
Laury McKean, RN

Amphotericin B, with or without the addition of flucytosine (5-FC), is the typical first-line therapy used for treating cryptococcal meningitis. In an Italian study, participants who received 5-FC in addition to amphotericin B, lived more than three times longer than participants who only received amphotericin (PO-B09-1400). However, because of the many side effects associated with amphotericin B, physicians often choose to use high dose fluconazole to treat less severe cases. Preliminary data from a prospective, randomized trial suggests that the addition of 5-FC to fluconazole treatment improves the efficacy of treatment. Fluconazole at doses of 800 mg, 1200 mg, or 1600 mg were used alone or in combination with 150 mg/kg a day of 5-FC. Of those individuals who received fluconazole alone, three of the nine individuals who received 800 mg, three of 11 who received 1200 mg, and one of four who received 1600 mg survived and became culture negative. However, when combined with 5-FC, five of seven who received 800 mg of fluconazole and four of five who received 1200 mg survived and became culture negative (WS-B12-5).

A study conducted in Rwanda compared itraconazole with amphotericin B. Forty-five individuals received 100 mg of intravenous itraconazole twice a day for one week, followed by 200 mg orally twice a day until CSF cultures became negative. Forty-seven individuals received 0.75 mg/kg of amphotericin B a day for six weeks. All participants were continued on 200 mg of oral itraconazole a day. Although the investigators concluded that itraconazole was an effective alternative as primary therapy, there were high failure rates in both arms of the study: 53% failure with itraconazole and 55% failure with amphotericin B. Additionally, only nine of the 45 individuals in the itraconazole group had a complete response, defined as survival at eight weeks with negative CSF cultures, whereas 21 of the 47 individuals receiving amphotericin B had a complete response (WS- B12-3).

Although little news was presented about it at the conference, another interesting drug being researched is liposomal amphotericin B. Liposomes are microscopic globules of fat that are impregnated with a particular drug, such as amphotericin B. They "deliver" that drug to diseased tissues more purposefully than standard intravenous preparations, which are poured into the bloodstream and saturate the entire body. Because of this unique delivery system, liposomal drugs tend to produce less toxicity. Liposomal amphotericin B (AmBisome) was studied in 12 indiviuals with cryptococcosis, 11 of whom were evaluable. Ten of the individuals were cured and one improved. Cultures were negative in nine of the 11 individuals and cerebrospinal fluid was cleared in 7 to 15 days (Lazar, JT, efficacy and safety of AmBisome in primary episodes of cryptococcosis in patients with HIV infection, VII Int AIDS Conf).
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Always watch for outdated information. This article first appeard in 1993. This material is designed to support, not replace, the relationship that exists between you and your doctor.

Copyright © 1993 - Seattle Treatment Education Project (STEP) - All rights reserved. Noncommercial reproduction is encouraged. STEP is published four times a year by the Seattle Treatment Education Project, 127 Broadway East, 3rd Floor, Seattle, WA 98102.    Email: step100@aol.com  STEP web page

This information is designed to support, not replace, the relationship that exists between you and your doctor.
©1993. AEGIS.