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Combination therapy with fluconazole and flucytosine for cryptococcal meningitis in Ugandan patients with AIDS.

Abstract
We performed a randomized trial in which combination therapy with fluconazole and short-term flucytosine was compared with fluconazole monotherapy in 58 patients with AIDS-associated cryptococcal meningitis (CM). Thirty of these patients were randomized to receive combination therapy with fluconazole, 200 mg once a day for 2 months, and flucytosine, 150 mg/(kg.d) for the first 2 weeks, and 28 were randomized to receive monotherapy with fluconazole at the same dose for 2 months. Patients in both groups who survived for 2 months received fluconazole as maintenance therapy at a dose of 200 mg three times per week for 4 months. The combination therapy prevented death within 2 weeks and significantly increased the survival rate among these patients (32%) at 6 months over that among patients receiving monotherapy (12%) (P = .022). The combination therapy also resulted in a significant decrease in the severity of headache after 1 month of treatment, compared with monotherapy (P = .005). No serious adverse reactions were observed in patients receiving either regimen. These data indicate that treatment with fluconazole and short-term flucytosine is a cost-effective and safe regimen that improves the quality of life for patients with AIDS-associated CM in developing countries where human immunodeficiency virus is endemic.
AuthorsH Mayanja-Kizza, K Oishi, S Mitarai, H Yamashita, K Nalongo, K Watanabe, T Izumi, Ococi-Jungala, K Augustine, R Mugerwa, T Nagatake, K Matsumoto
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 26 Issue 6 Pg. 1362-6 (Jun 1998) ISSN: 1058-4838 [Print] United States
PMID9636863 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
Chemical References
  • Antifungal Agents
  • Fluconazole
  • Flucytosine
Topics
  • AIDS-Related Opportunistic Infections (drug therapy)
  • Adult
  • Antifungal Agents (administration & dosage, therapeutic use)
  • Drug Therapy, Combination
  • Female
  • Fluconazole (administration & dosage, therapeutic use)
  • Flucytosine (administration & dosage, therapeutic use)
  • Humans
  • Male
  • Meningitis, Cryptococcal (drug therapy)
  • Middle Aged
  • Uganda

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