Selecting a Treatment Regimen
Table 4. Antifungal Treatment Recommendations for
Cryptococcal Meningoencephalitis in
HIV-Infected Individuals
Regimen
Duration
Evidence
AmBd (0.7-1.0 mg/kg per day)
plus flucytosine (100 mg/kg per day)a
2 weeks
A-I
Liposomal AmB (3-4 mg/kg per day) or
ABLC (5 mg/kg per day, with renal function concerns) plus
flucytosine (100 mg/kg per day)a
2 weeks
B-II
4-6 weeks
B-II
AmBd plus fluconazole
...
B-I
Fluconazole plus flucytosine
...
B-II
Fluconazole
...
B-II
Itraconazole
...
C-II
Consolidation therapy: Fluconazole (400 mg per day)
8 weeks
A-I
Maintenance therapy: Fluconazole (200 mg per day)a
≥1 yearc
A-I
Itraconazole (400 mg per day)d
≥1 yearc
C-I
AmBd (1 mg/kg per week)
≥1 year
C-I
Induction Therapy
AmBd (0.7-1.0 mg/kg per day) or liposomal AmB
(3-4 mg/kg per day) or ABLC (5 mg/kg per day,
for flucytosine-intolerant patients)
Alternatives for Induction Therapyb
Alternatives for Maintenance Therapy
c
d
c
Begin highly active antiretroviral therapy (HAART) 2-10 weeks after the start of initial antifungal
treatment.
b
In unique clinical situations in which primary recommendations are not available, consideration of
alternative regimens may be made—but not encouraged—as substitutes.
See full guidelines for dosages.
c
With successful introduction of HAART, a CD4 cell count ≥100 cells/mL, and low or nondetectable
viral load for ≥ 3 months with minimum of 1 year of antifungal therapy.
d
Inferior to the primary recommendation.
a
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