Journal Article

A Comparison of Itraconazole Versus Fluconazole as Maintenance Therapy for AIDS-Associated Cryptococcal Meningitis

Michael S. Saag, Gretchen A. Cloud, J. Richard Graybill, Jack D. Sobel, Carmelita U. Tuazon, Philip C. Johnson, W. Jeffrey Fessel, Bruce L. Moskovitz, Barbara Wiesinger, Dennis Cosmatos, Laura Riser, Carolynn Thomas, Richard Hafner and William E. Dismukes

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 28, issue 2, pages 291-296
Published in print February 1999 | ISSN: 1058-4838
Published online February 1999 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/515110
A Comparison of Itraconazole Versus Fluconazole as Maintenance Therapy for AIDS-Associated Cryptococcal Meningitis

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This study was designed to compare the effectiveness of fluconazole vs. itraconazole as maintenance therapy for AIDS-associated cryptococcal meningitis. HIV-infected patients who had been successfully treated (achieved negative culture of CSF) for a first episode of cryptococcal meningitis were randomized to receive fluconazole or itraconazole, both at 200 mg/d, for 12 months. The study was stopped prematurely on the recommendation of an independent Data Safety and Monitoring Board. At the time, 13 (23%) of 57 itraconazole recipients had experienced culture-positive relapse, compared with 2 relapses (4%) noted among 51 fluconazole recipients (P = .006). The factor best associated with relapse was the patient having not received flucytosine during the initial 2 weeks of primary treatment for cryptococcal disease (relative risk = 5.88; 95% confidence interval, 1.27–27.14; P = .04). Fluconazole remains the treatment of choice for maintenance therapy for AIDS-associated cryptococcal disease. Flucytosine may contribute to the prevention of relapse if used during the first 2 weeks of primary therapy.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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