Cryptococcal meningitis trial

Larsen RA, Leal MA, Chan LS. Fluconazole compared with amphotericin B plus flucytosine for cryptococcal meningitis in AIDS. A randomized trial. Ann Intern Med I990 II3(3) I83-7. 

Bozzette SA, Larsen RA, Chiu J, Leal MA, Jacobsen J, Rothman P, Robinson P, Gilbert G, McCutchan JA, Tilles J, et al. A placebo-controUed trial of maintenance therapy with fluconazole after treatment of cryptococcal meningitis in the acquired immunodeficiency syndrome. California Collaborative Treatment Group. N Engl J Med 1991 324(9) 580-4. 

Combination therapy with fluconazole (200 mg/day for 2 months) and flucytosine (150 mg/kg/day for the first 2 weeks n = 30) has been compared with fluconazole monotherapy (200 mg/day for 2 months n = 28) in a randomized open trial in Ugandan patients with AIDS-associated cryptococcal meningitis (12). Patients in both groups who survived for 2 months received maintenance therapy with fluconazole (200 mg three times per week for 4 months). There were no serious adverse events in any of the patients. The combination therapy prevented death within 2 weeks and significantly increased the survival rate at 6 months (32 versus 12%). However, the rate of positive cryptococcal antigen titers remained high at 2 months after treatment in both groups. 

Saag MS, Powderly WG, Cloud GA, et al. Comparison of amphotericin B with fluconazole in the treatment of acute AIDS-associated cryptococcal meningitis. The NIAID Mycoses Study Group and the AIDS Clinical Trials Group (see comments). N Engl J Med 1992 326 83-89. 

Powderly WG, Saag MS, Cloud GA, et al. A controlled trial of fluconazole or amphotericin B to prevent relapse of cryptococcal meningitis in patients with the acquired iimnunodeficiency syndrome. The NlAlD AIDS Clinical Trials Group and Mycoses Smdy Group. N Engl J Med 1992 326 793-798. 

Once the acute treatment of cryptococcal meningitis is completed, maintenance therapy is necessary to prevent relapse. Placebo-controUed trials of 100 to 200 mg/day fluconazole, as well as controlled trials versus 1 mg/kg per week of amphotericin B, have been conducted to prevent recurrence of cryptococcal disease in patients who completed acute therapy. Compared with patients receiving amphotericin B maintenance therapy, the probabihty of remaining relapse-free at 1 year was higher for fluconazole recipients (97% ver-... 

Brouwer AE, Rajanuwong A, Chierakul W, Griffen GE, Larsen RA, White NJ, Harrison TS. Combination antifungal dierapies for HIV-associated cryptococcal meningitis a randomised trial. Lancet (2004) 363, 1764-7. 

Bicanic T, Wood R, Meintjes G, Rebe K, Brouwer A, Loyse A, Bekker LG, Jaffar S, Harrison T. High-dose amphotericin B with flucytosine for the treatment of cryptococcal meningitis in HTV-infected patients a randomized trial Clin Infect Dis 2008 47 131-2. 

Sobel JD, Filler SG. A phase II randomized trial of amphotericin B alone or combined with fluconazole in the treatment of HIV-associated cryptococcal meningitis. Chn Infect Dis 2009 48 1775-83. 

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