Selecting a Treatment Regimen
Table 4. Antifungal Treatment Recommendations for Cryptococcal Meningoencephalitis in HIV-Infected Individuals
Regimen Induction Therapy
AmBd (0.7-1.0 mg/kg per day) plus flucytosine (100 mg/kg per day)a
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
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 AmBd plus fluconazole
Fluconazole plus flucytosine Fluconazole Itraconazole
Consolidation therapy: Fluconazole (400 mg per day) Maintenance therapy: Fluconazole (200 mg per day)a
Alternatives for Maintenance Therapyc Itraconazole (400 mg per day)d AmBd (1 mg/kg per week)d
a b 2 weeks 2 weeks 4-6 weeks A-I B-II B-II Duration Evidence
... ... ... ...
8 weeks ≥1 yearc
≥1 yearc ≥1 yearc
B-I
B-II B-II C-II A-I A-I
C-I C-I
Begin highly active antiretroviral therapy (HAART) 2-10 weeks aſter the start of initial antifungal treatment.
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.
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.
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