Key Points
ÎÎCryptococcosis is a global invasive mycosis associated with significant
morbidity and mortality.
ÎÎCryptococcosis remains a challenging management issue, with little new
drug development or recent definitive studies.
ÎÎIf the diagnosis is made early, if clinicians adhere to the basic principles
of these guidelines, and if the underlying disease is controlled, then
cryptococcosis can be managed successfully in the vast majority of patients.
Selecting a Treatment Regimen
Strength of Recommendation and Evidence Quality
Strength
Definition
A
B
C
Quality
I
II
Good evidence for or against a recommendation
Moderate evidence for or against a recommendation
Poor evidence to support a recommendation
Definition
Evidence from ≥ 1 randomized, controlled trial
Evidence from ≥ 1 clinical trial, without randomization, from cohort or case-controlled
analytic studies (preferably from > 1 center), from multiple time-series, or dramatic
results from uncontrolled experiments
Opinions of respected authorities, based on experience, descriptive studies, or reports of
expert committees
III
Table 1. Antifungal Treatment Recommendations for
Nonmeningeal Cryptococcosis
Patient Group
Immunosuppressed patients
and immunocompetent
patients with mild-tomoderate cryptococcosis
Immunosuppressed patientsa
and immunocompetent
patients with severe pulmonary
cryptococcosis
Initial Antifungal
Regimen
Duration
Evidence
Fluconazole
(400 mg per day)
6-12 months
B-III
12 months
B-III
Same as central
nervous system
(CNS) disease
Patients with Nonmeningeal, Nonpulmonary Cryptococcosis
Patients with cryptococcemia
Same as CNS disease
12 months
B-III
Patients for whom CNS
disease has been ruled out with
no fungemia, with a single
site of infection, and with
no immunosuppressive risk
factors
Fluconazole
(400 mg per day)
6-12 months
B-III
a
Directly rule out CNS disease with lumbar puncture.
