Thirty-one consecutive
AIDS patients with cryptococcal disease were enrolled in a study of the efficacy and safety of short-course primary treatment with a relatively high dose of
amphotericin B (1 mg/[kg.d] for 14 days); 26 patients also received
flucytosine (100-150 mg/[kg.d], given either intravenously or orally). Twenty-five patients had
cryptococcal meningitis confirmed by culture, three had presumed
cryptococcal meningitis, and three had disseminated extrameningeal
cryptococcosis. After successful primary treatment, all patients were given oral
itraconazole or
fluconazole as suppressive
therapy, and their lifelong clinical and mycologic follow-up was planned. Successful primary
therapy was defined as the resolution of symptoms and the documentation of negative cultures of cerebrospinal fluid and/or blood 2 months after the initial diagnosis.
Therapy was successful in 29 (93.5%) of all 31 cases and in 26 (92.8%) of the 28 cases of culture-proven or presumed
cryptococcal meningitis. Nephrotoxicity developed as a result of
amphotericin B administration in seven cases; this adverse reaction required a reduction of the dose in two cases and the discontinuation of
therapy in five. No deaths due to
cryptococcosis were documented during primary
therapy. Treatment failed in two cases. During a mean observation period of 10.7 months, three relapses of the underlying
infection occurred. Our results indicate that an aggressive approach to the primary treatment of
cryptococcosis in
AIDS patients, with the administration of a relatively high dose of
amphotericin B for a relatively short period, is effective and well tolerated.