2007
DOI: 10.1086/518607
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Fungal Burden, Early Fungicidal Activity, and Outcome in Cryptococcal Meningitis in Antiretroviral-Naive or Antiretroviral-Experienced Patients Treated with Amphotericin B or Fluconazole

Abstract: In a prospective observational study of 54 patients with human immunodeficiency virus-associated cryptococcal meningitis, the early fungicidal activity of amphotericin B (1 mg/kg/day) was significantly greater than that of fluconazole (400 mg/day). Compared with antiretroviral therapy-naive patients, patients developing cryptococcal meningitis while already receiving antiretroviral therapy had lower baseline fungal burdens and a longer median duration of survival, but there were no differences observed in fung… Show more

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Cited by 248 publications
(248 citation statements)
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“…In South African adults amphotericin B 1 mg/kg/dose is well tolerated. 17 Amphotericin B in the induction phase should be given for 2 weeks; however, 7 -10 days may suffice. 18 Where amphotericin B is unavailable or cannot be given safely, transfer the patient to a centre where amphotericin B is available.…”
Section: Antifungal Treatment Of a First Episode Of CCmentioning
confidence: 99%
See 1 more Smart Citation
“…In South African adults amphotericin B 1 mg/kg/dose is well tolerated. 17 Amphotericin B in the induction phase should be given for 2 weeks; however, 7 -10 days may suffice. 18 Where amphotericin B is unavailable or cannot be given safely, transfer the patient to a centre where amphotericin B is available.…”
Section: Antifungal Treatment Of a First Episode Of CCmentioning
confidence: 99%
“…Amphotericin B is superior to fluconazole at lower fluconazole doses. 17,19,20 There are no studies comparing higher dose fluconazole with amphotericin B, but given that fluconazole is fungistatic, amphotericin B should always be the drug of first choice.…”
Section: Antifungal Treatment Of a First Episode Of CCmentioning
confidence: 99%
“…Patients with cryptococcal meningitis (CM) in Southern Africa present with median CD4 + counts <50 cells/µl, [1][2][3][4] with a high prevalence of co-morbidities such as tuberculosis (TB) and Kaposi's sarcoma. In this context, the challenge is to balance the competing risks of morbidity and mortality from each additional week of advanced immuno suppressionwell demonstrated in South African (SA) HIV cohorts waiting to start antiretroviral therapy (ART) [5] -with those from immune reconstitution inflammatory syndrome (IRIS) occur r ing within the confined space of the central nervous system, when ART is commenced in the presence of a high fungal antigen load.…”
mentioning
confidence: 99%
“…[6,7] The first Southern African CM guide line [8] published in 2008 recommended treatment with 1 mg/kg/day amphotericin B for 2 weeks -a regimen known to drive down the cryptococcal burden rapidly in cerebrospinal fluid (CSF), with many patients having sterile CSF by day 14. [1] At this time, given the lack of evidence regarding ART timing in CM, it was recommended to start ART 2 -4 weeks after commencing amphotericin B. [8] This window pragmatically coincided with the timing of hospital discharge, and the switch from amphotericin induction therapy to consolidation with fluconazole, with the aim of having asymptomatic patients with sterile or almost-sterile CSF counselled and ready to start ART at outpatient follow-up 4 weeks into antifungal therapy.…”
mentioning
confidence: 99%
“…4 In research settings in South Africa, utilising optimal amphotericin B-based treatments, acute mortality of CM is between 24 and 37%. 5,6 Lessells et al suggest that, in routine care settings, mortality rates are higher. 1 From their study conducted at Hlabisa Hospital in rural Kwazulu-Natal, they report 41% in-hospital mortality (all of which deaths occurred within 30 days of admission), which is in keeping with data from Johannesburg, where only 33% of CM patients were known to be alive and under follow-up at 12 weeks (Govender N, unpublished).…”
mentioning
confidence: 99%