Journal Article

Combination Therapy with Fluconazole and Flucytosine for Cryptococcal Meningitis in Ugandan Patients with AIDS

Harriet Mayanja Kizza, Kazunori Oishi, Satoshi Mitarai, Hiroshi Yamashita, Kisembo Nalongo, Kiwao Watanabe, Takashi Izumi, Ococi Jungala, Kaddhu Augustine, Roy Mugerwa, Tsuyoshi Nagatake and Keizo Matsumoto

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 26, issue 6, pages 1362-1366
Published in print June 1998 | ISSN: 1058-4838
Published online June 1998 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/516372
Combination Therapy with Fluconazole and Flucytosine for Cryptococcal Meningitis in Ugandan Patients with AIDS

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We performed a randomized trial in which combination therapy with fluconazole and shortterm flucytosine was compared with fluconazole monotherapy in 58 patients with AIDS-associated cryptococcal meningitis (CM). Thirty of these patients were randomized to receive combination therapy with fluconazole, 200 mg once a day for 2 months, and flucytosine, 150 mg/(kg·d) for the first 2 weeks, and 28 were randomized to receive monotherapy with fluconazole at the same dose for 2 months. Patients in both groups who survived for 2 months received fluconazole as maintenance therapy at a dose of 200 mg three times per week for 4 months. The combination therapy prevented death within 2 weeks and significantly increased the survival rate among these patients (32%) at 6 months over that among patients receiving monotherapy (12%) (P = .022). The combination therapy also resulted in a significant decrease in the severity of headache after 1 month of treatment, compared with monotherapy (P = .005). No serious adverse reactions were observed in patients receiving either regimen. These data indicate that treatment with fluconazole and short-term flucytosine is a cost-effective and safe regimen that improves the quality of life for patients with AIDSassociated CM in developing countries where human immunodeficiency virus is endemic.

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

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