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Fluconazole combined with flucytosine for treatment of cryptococcal meningitis in patients with AIDS.
Larsen RA; Bozzette SA; Jones BE; Haghighat D; Leal MA; Forthal D; Bauer
April 30, 1995
Clin Infect Dis. 1994 Oct;19(4):741-5. Unique Identifier : AIDSLINE

Treatment of cryptococcal meningitis with amphotericin B or fluconazole is often unsuccessful; in only 35%-40% of cases do CSF cultures become negative by 10 weeks after initiation of such therapy. We conducted a prospective, open-label clinical trial involving persons with AIDS to determine whether the rate of clinical success would improve when fluconazole (400 mg daily) was combined with flucytosine (150 mg/kg daily). At the conclusion of 10 weeks of therapy, 75% (95% confidence interval, 58%-87%) of 32 subjects' CSF cultures were negative. The Kaplan-Meier estimate of clinical success at 10 weeks was 63% (95% confidence interval, 48%-82%). The median time to negativity of the CSF culture was 23 days. Toxic side effects that were sufficiently severe to lead to the withdrawal of flucytosine were observed in nine subjects (28%). In this pilot study of fluconazole combined with flucytosine, the rate of clinical success at 10 weeks was greater than that previously reported with regard to the use of fluconazole alone or amphotericin B alone.

Adult AIDS-Related Opportunistic Infections/*DRUG THERAPY Cerebrospinal Fluid/MICROBIOLOGY Cryptococcus neoformans/ISOLATION & PURIF Drug Therapy, Combination Female Fluconazole/ADMINISTRATION & DOSAGE/*THERAPEUTIC USE Flucytosine/ADMINISTRATION & DOSAGE/ADVERSE EFFECTS/*THERAPEUTIC USE Human Male Meningitis, Cryptococcal/CEREBROSPINAL FLUID/*DRUG THERAPY Pilot Projects Prospective Studies Support, Non-U.S. Gov't Survival Analysis CLINICAL TRIAL JOURNAL ARTICLE