Cryptococcal infections

Trade names 5-FC Alcobon Ancobon Ancotil Indications Candidal and cryptococcal infections Category Antimycobacterial Half-life 3-8 hours... 

Use in combination with amp B in severe candidal and cryptococcal infections—enters CSF. Toxic to bone marrow (see Anticancer Drugs). 

Saag MS, Graybill RJ, Larsen RA, et al. Practice guidelines for the management of cryptococcal disease. Infectious Diseases Society of America. Clin Infect Dis 2000 30 710-718. 

A 26-year-old female with acquired immunodeficiency syndrome (AIDS) develops cryptococcal meningitis. She refuses all intravenous medication. Which antifungal agent can be given orally to treat the meningeal infection ... 

Cryptococcal meningitis in HIV Treatment of cryptococcal meningitis in HIV-infected patients AmBisome only). 

A significant decrease in mortality from deep-seated mycoses was noted among bone marrow transplant recipients treated prophylactically with fluconazole, but similar benefits have not been seen in leukemia patients receiving prophylactic fluconazole. Fluconazole taken prophylactically by end-stage AIDS patients can reduce the incidence of cryptococcal meningitis, esophageal candidiasis, and superficial fungal infections. 

Despite negligible cerebrospinal fluid concentrations, itraconazole shows promise in the treatment of cryptococcal and coccidioidal meningitis. Additional uses for itraconazole include treatment of vaginal candidiasis, tinea versicolor, dermatophyte infections, and onychomycosis. Fungal naU infections account for most use of this drug in the outpatient setting. 

The aim of this study reported by Powderly et al. (1992) was to establish the non-inferiority of a test treatment, fluconazole, compared to an established treatment, amphotericin B, in preventing the relapse of cryptococcal meningitis in HIV-infected patients. It was thought that fluconazole would be less effective than amphotericin B, but would offer other advantages in terms of reduced toxicity and ease of administration fluconazole was an oral treatment while amphotericin B was given intravenously. The non-inferiority margin was set at —15 per cent in terms of relapse rates. 

It is indicated in mucosal candidiasis, systemic candidiasis, crypttococcosis, prophylaxis of fungal infections following cytotoxic chemotherapy or radiotherapy maintenance to prevent relapse of cryptococcal meningitis in patients with AIDS sporotrichosis, histoplasmosis and vaginal candidiasis. 

To decrease dose-related toxicity by using reduced doses of one or more components of the drug regimen. The use of flucytosine in combination with amphotericin for the treatment of cryptococcal meningitis in non-HIV-infected patients allows for a reduction in amphotericin dosage with decreased amphotericin -induced nephrotoxicity. 

Indications Treatment of oropharyngeal and esophageal candidiasis and may be effective for the treatment of serious systemic candidal infections Cryptococcal meningitis c <... 

Intra-abdominal infection Meningitis (cryptococcal, fungal)... 

Mavinkurve-Groothuis AMC, Bokkerink JPM, Verweij PE, Veerman AJP, Hoogerbrugge PM. Cryptococcal meningitis in a child with acute lymphoblastic leukemia. Pediatr Infect Dis J 2003 22 576. 

In the treatment of entero-coccal endocarditis with penicillin and streptomycin or cryptococcal meningitis infections with amphotericin B in combination with flucytosine. 

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