Treatment
Cryptococcosis that does not affect the central nervous system can be treated with fluconazole alone.
Cryptococcal meningitis should be treated for two weeks with intravenous Amphotericin B 0.7–1.0 (mg/kg)/day and oral flucytosine 100 (mg/kg)/day (or intravenous flucytosine 75 (mg/kg)/day if the patient is unable to swallow). This should then be followed by oral fluconazole 200 mg daily for ten weeks and then 200 mg daily until the patient's CD4 count is above 100 for three months and, if infected, his HIV viral load is undetectable.
Intravenous Ambisome 4 (mg/kg)/day may be used but is not superior: its main use is in patients who do not tolerate Amphotericin B. The 200 (mg/kg)/day dose for flucytosine is not more effective, is associated with more side-effects and should not be used.
In Africa, oral fluconazole at a rate of 200 mg daily is used. However, this does not result in cure because it merely suppresses the fungus and does not kill it; viable fungus can continue to be grown from CSF of patients who have taken fluconazole for many months. An increased dose of 400 mg daily does not improve outcomes, but preliminary data from Uganda shows that very high doses of 1200 mg or more per day may be effective. The duration of this treatment and the post-treatment maintenance dose is not known.
Read more about this topic: Cryptococcus Neoformans
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