Figure 1. Non-Meningeal Cryptococcosis
Mild-to-Moderate Disease
Severe Pulmonary Diseasea
Nonpulmonary Cryptococcemia
No Fungemia, Single Site of Infection, and No Immunosuppressive Risk Factors
Cerebral Cryptococcomas Treatment:
Fluconazole (400 mg per day) Duration: 6-12 months, B-III
Treatment: Same as CNS disease
Duration: 12 months, B-III Treatment:
Fluconazole 400 mg per day
Duration: 6-12 months, B-III Induction Therapy:
AmBd (0.7-1.0 mg/kg per day IV),
liposomal AmB (3-4 mg/kg per day IV), or ABLC (5 mg/kg per day IV)
PLUS flucytosine (100 mg/kg per day orally in 4 divided doses) Duration: ≥ 6 weeks, B-III
Consolidation and Maintenance:
Fluconazole (400-800 mg per day orally) Duration: 6-18 months, B-III
Induction Therapy:
AmBd (1 mg/kg per day IV) or liposomal AmB (5 mg/kg per day)b ABLC (5 mg/kg per day)b
Children with CNS and Disseminated Disease
or
PLUS flucytosine (100 mg/kg per day orally in 4 divided doses) Duration: 2 weeks
Consolidation:
Fluconazole (10-12 mg/kg per day orally) Duration: ≥ 8 weeks, B-III
Maintenance:
Fluconazole (6 mg/kg per day orally) Duration: ≥ 12 months, B-II
Children with Cryptococcal Pneumonia
Treatment:
Fluconazole (6-12 mg/kg per day orally) Duration: ≥ 12 months, B-II
a In immunosuppressed patients, directly rule out CNS disease with lumbar puncture. b For AmB-intolerant patients.
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