Skip to main content

Cryptococcal Meningitis in AIDS Patients A Pilot Study of Fluconazole Therapy in 52 Patients

  • Chapter

Summary

Cryptococcal meningitis in AIDS patients is liable to relapse and carries a high mortality rate. Standard treatment with amphotericin B and 5-fluorocytosine is limited by toxic effects. In the present study 64 AIDS patients with cryptococcal meningitis were admitted to a multicentre trial of fluconazole given either orally or intravenously. After a loading dose of 400 mg, two dosage regimens were adopted: 150–200 mg, or 400 mg daily for at least 45–60 days; subsequent maintenance therapy was 100 or 200 mg daily for both groups. Forty seven of the 52 evaluable patients were alive and improved or asymptomatic at day 60 and respectively 7 of 14 and 27 of 31 of those on 200 mg or 400 mg per day had negative cultures of the cerebrospinal fluid. Relapse rate under maintenance therapy was 23%. Fluconazole was well tolerated and free from severe side effects. These results merit further study of fluconazole, either alone or in combination.

(M. Armengaud, J.P. Bleriot, J.P. Brion, G. Calamy, A. Chapman, J.P. Coulaud, P. de Truchis, G. Humbert, C. Lafaix, J. Modai, M. Obadia, O. Patey, J. Prinseau, F. Raffi, W. Rosenbaum, R. Roue, F. Vachon, A. Vergnenegre)

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Bennett, J.E., Dismukes, W.E., Duma, T.R. et al., 1975, A comparison of amphotericin B alone and combined with flucytosine in the treatment of cryptococcal meningitis, N. Engl. J. Med., 301:126.

    Article  Google Scholar 

  • Byrne, W.R., and Wajszczuk, C.P., 1988, Cryptococcal meningitis in AIDS: successful treatment with fluconazole after failure of amphotericin B, Ann. Intern. Med., 108:384.

    PubMed  CAS  Google Scholar 

  • Chuck, S.L., and Sande, M.A., 1989, Infections with Cryptococcus neoformans in the acquired immunodeficiency syndrome, N. Engl. J. Med., 21:794.

    Article  Google Scholar 

  • Dismukes, W.E., 1988, Cryptococcal meningitis in patients with AIDS, J. Infect. Dis., 157:624.

    Article  PubMed  CAS  Google Scholar 

  • Dismukes, W., Cloud, G., Thompson, S., Sugar, A. et al., NIAID mycoses study group, 1989, Fluconazole versus amphotericin B therapy of acute cryptococcal meningitis, Abstract No. 1065, ICAAC.

    Google Scholar 

  • Dupont, B., and Drouhet, E., 1987, Cryptococcal meningitis and fluconazole, Ann. Intern. Med., 106:778.

    PubMed  CAS  Google Scholar 

  • Eng, R.H.K., Bishburg, E., Smith, S.M., and Kapila, R., 1986, Cryptococcal infections in patients with acquired immune deficiency syndrome, Am. J. Med., 81:19.

    Article  PubMed  CAS  Google Scholar 

  • Gans de, J., Eeftinck Schattenkerk, J.K.M., and Ketel, V.R.J., 1988, Itraconazole as maintenance treatment for crytococcal meningitis in the acquired immune deficiency syndrome, Br. Med. J., 296.

    Google Scholar 

  • Graybill, J.R., 1987, Fluconazole efficacy in animal models of mycotic diseases, in: “Recent Trends in the discovery, Development and Evaluation of Antifungal Agents”, R.A. Fromtling, ed., Prous Science, Barcelona.

    Google Scholar 

  • Katlama, C., Leport, C., Matheron, S. et al., 1984, Acquired immunodeficiency syndrome in Africans, Ann. Soc. Belge Med. Trop., 64:379.

    CAS  Google Scholar 

  • Kovacs, J.A., Kowacs, A.A., Polis, M. et al., 1985, Cryptococcosis in the acquired immunodeficiency syndrome, Ann. Intern. Med., 103:533.

    PubMed  CAS  Google Scholar 

  • Larsen, R.A., and Leal, M.E., 1989, Fluconazole compared to amphotericin B as treatment of cryptococcal meningitis, Abstract No. 10 62, ICAAC.

    Google Scholar 

  • Perfect, J.R., Savani, D.V., and Durack, D.T., 1986, Comparison of itraconazole and fluconazole in treatment of cryptococcal meningitis and candida pyelonephritis in rabbits, Antimicrob. Agents Chemother., 29:579.

    PubMed  CAS  Google Scholar 

  • Piot, P., Taelman, H., Rapita, B.M. et al., 1984, Acquired immunodeficiency syndrome in a heterosexual population in Zaire, Lancet, 2:65.

    Article  PubMed  CAS  Google Scholar 

  • Stern, J.J., Hartman, B.J., Sharkey, P., Rowland, V., Squires, K.E., Murray, H.W., and Graybill, R., 1988, Oral fluconazole therapy for patients with acquired immunodeficiency syndrome and cryptococcosis: experience with 22 patients, Am. J. Med., 85:477.

    Article  PubMed  CAS  Google Scholar 

  • Sugar, A.M., and Saunders, C., 1988, Oral fluconazole as suppressive therapy of disseminated cryptococcosis in patients with acquired immunodeficiency syndrome, Am. J. Med., 85:481.

    Article  PubMed  CAS  Google Scholar 

  • Van Cutsem, J., Van Gerven, F., and Janssen, P.A.J., 1987, The in vitro and in vivo antifungal activity of itraconazole, in: “Recent Trends in the Discovery, Development and Evaluation of Antifungal Agents”, R.A. Fromtling, ed., Prous Science, Barcelona.

    Google Scholar 

  • Van ‘t Wout, J.W., de Graeff-Meeder, E.R., Paul, L.C., Kuis, W., and Van Furth, R., 1988, Treatment of two cases of cryptococcal meningitis with fluconazole, Scand. J. Infect. Dis., 20:193.

    Article  Google Scholar 

  • Viviani, M.A., Tortorana, A.M., and Giani, P.C., 1987, Itraconazole for cryptococcal infection in the acquired immunodeficiency syndrome, Ann. Intern. Med., 106.

    Google Scholar 

  • Zuger, A., Lonie, E., Molzmann, R.S., Simberkoff, M.S., and Rahal, J.J., 1988, Cryptococcal disease in patients with the acquired immunodeficiency syndrome, Ann. Intern. Med., 104:234.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Consortia

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1990 Plenum Press, New York

About this chapter

Cite this chapter

Dupont, B. et al. (1990). Cryptococcal Meningitis in AIDS Patients A Pilot Study of Fluconazole Therapy in 52 Patients. In: Bossche, H.V., Mackenzie, D.W.R., Cauwenbergh, G., Van Cutsem, J., Drouhet, E., Dupont, B. (eds) Mycoses in AIDS Patients. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-0655-9_27

Download citation

  • DOI: https://doi.org/10.1007/978-1-4613-0655-9_27

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4612-7912-9

  • Online ISBN: 978-1-4613-0655-9

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics