ArticleBMC infectious diseases2006
Outcome of AIDS-associated cryptococcal meningitis initially treated with 200 mg/day or 400 mg/day of fluconazole.
Article in BMC infectious diseases, 2006. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Treatment for HIV-associated cryptococcal meningitis.The Cochrane database of systematic reviews · 2018Pooled it
- Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2010Guideline
- The effect of therapeutic lumbar punctures on acute mortality from cryptococcal meningitis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2014Trial
- Primary prophylaxis of cryptococcal disease with fluconazole in HIV-positive Ugandan adults: a double-blind, randomised, placebo-controlled trial.The Lancet. Infectious diseases · 2011Trial
- Combination flucytosine and high-dose fluconazole compared with fluconazole monotherapy for the treatment of cryptococcal meningitis: a randomized trial in Malawi.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2010Trial
- Induction Treatment for HIV-Associated Cryptococcal Meningitis: Where Have We Been and Where Are We Going?Microorganisms · 2025Review
- Management and outcome of intracranial fungal infections in children and adults in Africa: a scoping review.BMC infectious diseases · 2024Article
- Exposure ofPathogens (Basel, Switzerland) · 2023Article
- Combination Therapy for HIV-Associated Cryptococcal Meningitis-A Success Story.Journal of fungi (Basel, Switzerland) · 2021Review
- Cryptococcal meningitis: A neglected NTD?PLoS neglected tropical diseases · 2017Article
- Minimizing fungal disease deaths will allow the UNAIDS target of reducing annual AIDS deaths below 500 000 by 2020 to be realized.Philosophical transactions of the Royal Society of London. Series B, Biological sciences · 2016Review
- MORTALITY AFTER CLINICAL MANAGEMENT OF AIDS-ASSOCIATED CRYPTOCOCCAL MENINGITIS IN KENYA.East African medical journal · 2014Article
- Cryptococcal meningitis: epidemiology and therapeutic options.Clinical epidemiology · 2014Review
- Flucytosine and cryptococcosis: time to urgently address the worldwide accessibility of a 50-year-old antifungal.The Journal of antimicrobial chemotherapy · 2013Review
- Cryptococcal meningoencephalitis in human immunodeficiency virus/acquired immunodeficiency syndrome in douala, cameroon: a cross sectional study.North American journal of medical sciences · 2013Article
- New Insights into HIV/AIDS-Associated Cryptococcosis.ISRN AIDS · 2013Review
- A repurposing approach identifies off-patent drugs with fungicidal cryptococcal activity, a common structural chemotype, and pharmacological properties relevant to the treatment of cryptococcosis.Eukaryotic cell · 2013Article
- Predictors of outcome in routine care for Cryptococcal meningitis in Western Kenya: lessons for HIV outpatient care in resource-limited settings.Postgraduate medical journal · 2013Article
- Article
- Treatment of cryptococcal meningitis in resource limited settings.Current opinion in infectious diseases · 2009Review
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAIDS-associated cryptococcal meningitis has a high mortality. Fluconazole was the only systemic antifungal therapy available in our centre. From 1999-2001 we used low-dose fluconazole (200 mg daily initially), and did not offer therapy to patients perceived to have poor prognoses. In 2001 donated fluconazole became available, allowing us to use standard doses (400 mg daily initially). Antiretroviral therapy was not available during the study period.
methodsRetrospective chart review of adult patients before and after the fluconazole donation.
results205 patients fulfilled the inclusion criteria, 77 before and 128 after the donation. Following the donation fewer patients received no antifungal treatment (5% vs 19%, p = 0.002), and more patients received standard-dose fluconazole (90% vs 6%, p < 0.001). In-hospital mortality was 25%. Impaired consciousness, no antifungal treatment received and cerebrospinal fluid antigen titre > 1,000 were independent predictors of in-hospital mortality. Concomitant rifampicin did not affect in-hospital survival. Thirteen patients were referred to the tertiary referral hospital and received initial treatment with amphotericin B for a mean of 6 days - their in-hospital survival was not different from patients who received only fluconazole (p = 0.9). Kaplan-Meier analysis showed no differences in length of survival by initial treatment with standard or low doses of fluconazole (p = 0.27 log rank test); median survival was 76 and 82 days respectively.
conclusionOutcome of AIDS-associated cryptococcal meningitis is similar with low or standard doses of fluconazole. The early mortality is high. Initial therapy with amphotericin B and other measures may be needed to improve outcome.
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