Maintenance therapy with fluconazole 200mg daily is generally advised for individuals until the CD4 cell count is consistently greater than 100 cells per cubic ml and there is a low or undetectable HIV viral RNA for at least 3 months.Īmphotericin B deoxycholate and lipid formulations of amphotericin B could be used alone or with fluconazole administered at a dose of 800mg per day (12mg/kg per day) for at least 2 weeks followed by fluconazole 800mg daily for a minimum of 8 weeks. Lipid formulations of amphotericin B at doses from 3 to 6mg/kg daily can be substituted for amphotericin deoxycholate in circumstances among patients with or predisposed to renal dysfunction. Primary therapy with amphotericin B deoxycholate +/- flucytosine 100mg/kg per day orally in four divided doses is administered for at least 2 weeks followed by fluconazole at least 400mg daily (6 mg/kg) for a minimum of 8 weeks. A general therapeutic approach to patients with CNS and other life-threatening forms of cryptococcosis is a step-wise approach with “induction therapy” consisting of 2 or more weeks of therapy with an amphotericin B formulation, with or without flucytosine, followed by a transition to oral therapy, generally fluconazole, once the patient is stable. For patients with more severe pulmonary disease and for most patients with extra-pulmonary cryptococcosis, including all patients with central nervous system (CNS) involvement, amphotericin B, either in its conventional (deoxycholate) or a lipid formulation, is advised.įor patients with CNS or severe extra-neural disease, the addition of flucytosine is advocated by most experts. Most infections limited to the lungs can be effectively managed with fluconazole for non-life-threatening, mild to moderate disease. Generally speaking, hosts are divided into one of three major groups: HIV positive individuals, organ transplant recipients/patients with other immunocompromising conditions, and phenotypically “normal” individuals. The preferred therapy for cryptococcosis is dependent on the site and severity of infection and the underlying host disorder.
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