The Hidden Danger of Primary Fluconazole Prophylaxis for Patients with AIDS

Abstract

and §32 mg/mL, respectively [2]. The first patient received a amphotericin B (0.6 mg/kg) and flucytosine (100 mg/kg) followed Downloaded from https://academic.oup.

In vitro susceptibility characteristics of Cryptococcus neoformans varieties from AIDS patients in Goiânia, Brazil

“…Our data are similar to those reported by other investigators who used the same methodology (Alves et al 2001). However some cases of meningitis due to C. neoformans resistant to fluconazole have been reported in AIDS patients (Peetermans et al 1993, Berg et al 1998.…”

In vitro antifungal susceptibility profiles and genotypes of 308 clinical and environmental isolates of Cryptococcus neoformans var. grubii and Cryptococcus gattii serotype B from north-western India

“…It may be added in this context that relapses in patients with AIDSassociated cryptococcosis are often due to deterioration of the host immune function rather than to an increase in MICs (Witt et al, 1996). However, a rising MIC of fluconazole has been implicated in clinical relapse in patients with AIDS-associated cryptococcal meningitis (Paugam et al, 1994;Birley et al, 1995;Currie et al, 1995;Armengou et al, 1996;Berg et al, 1998;Davey et al, 1998;Aller et al, 2000).…”

Global Trends in the Antifungal Susceptibility of Cryptococcus neoformans (1990 to 2004)

“…Pharmacologic management of cryptococcal infections usually consists of primary therapy with amphotericin B, with or without flucytosine, followed by maintenance therapy, or in some instances life-long suppressive therapy, with fluconazole (43). High rates of fungal persistence and frequent disease relapse have sparked a growing concern among clinicians regarding the potential for the emergence of antifungal resistance among Cryptococcus neoformans (8,11).…”

“…Most of these reports involve resistance to fluconazole emerging in the setting of meningitis in AIDS patients after long treatments or prophylaxis with fluconazole (7,8,34). Recent reports from Cambodia (12,44) and from India (16) have raised the concern of a more widespread increase in fluconazole resistance among C. neoformans, suggesting the need for greater vigilance and more-widespread surveillance.…”