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Combo Treatment Effective for Cryptococcal Meningitis

Combo Treatment Effective for Cryptococcal Meningitis

Treatment with amphotericin B plus flucytosine improves survival versus amphotericin B alone

THURSDAY, April 4 (HealthDay News) -- In HIV-infected patients with cryptococcal meningitis, treatment with amphotericin B plus flucytosine is more effective for improving survival than treatment with amphotericin B alone, according to a study published in the April 4 issue of the New England Journal of Medicine.

Jeremy N. Day, M.D., Ph.D., from Oxford University Clinical Research Unit in Ho Chi Minh City, Vietnam, and colleagues randomly assigned 299 HIV-infected patients with cryptococcal meningitis to 1 mg/kg per day amphotericin B for four weeks; 1 mg/kg per day amphotericin B plus 100 mg/kg per day flucytosine for two weeks; or 1 mg/kg per day amphotericin B plus 400 mg twice daily fluconazole for two weeks.

The researchers found that there were significantly fewer deaths in the group receiving amphotericin B plus flucytosine compared with amphotericin B alone, both after 14 days (hazard ratio, 0.57; unadjusted P = 0.08) and after 70 days (hazard ratio, 0.61; unadjusted P = 0.04). Amphotericin B plus flucytosine treatment correlated with significantly elevated rates of yeast clearance from cerebrospinal fluid. In contrast, treatment with amphotericin B plus fluconazole had no significant effect on survival compared with amphotericin B alone at 14 days (hazard ratio, 0.78; P = 0.42) and 70 days (hazard ratio, 0.71; P = 0.13). The three groups had similar rates of adverse events, according to the study.

"Amphotericin B plus flucytosine, as compared with amphotericin B alone, is associated with improved survival among patients with cryptococcal meningitis," Day and colleagues conclude. "A survival benefit of amphotericin B plus fluconazole was not found."

Abstract (http://www.nejm.org/doi/full/10.1056/NEJMoa1110404 )Full Text (subscription or payment may be required) (https://cdf.nejm.org/subscribe/sub_onestep.aspx?prc=ONJGNOV2&promo=ONJGNOV2&cpc=SODPNEJC1212A )