ArticlePloS one2008
Major role for amphotericin B-flucytosine combination in severe cryptococcosis.
Article in PloS one, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 56 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.
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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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
56 citing papers in PubMed, 2 syntheses or guidelines pooled it, 141 citations in OpenAlex.
- Comparison of flucytosine and fluconazole combined with amphotericin B for the treatment of HIV-associated cryptococcal meningitis: a systematic review and meta-analysis.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2014Pooled 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
- Combination antifungal therapy for cryptococcal meningitis.The New England journal of medicine · 2013Trial
- Antifungal Activity of Selected Naphthoquinones and Their Synergistic Combination with Amphotericin B AgainstAntibiotics (Basel, Switzerland) · 2025Article
- Collateral sensitivity counteracts the evolution of antifungal drug resistance in Candida auris.Nature microbiology · 2024Article
- Novel combinatorial approach: Harnessing HIV protease inhibitors to enhance amphotericin B's antifungal efficacy in cryptococcosis.PloS one · 2024Article
- Cryptococcosis in kidney transplant recipients: Current understanding and practices.World journal of nephrology · 2023Review
- Non-meningeal, non-pulmonary cryptococcosis with limited posterior uveitis in a kidney organ transplant recipient with antibody-mediated rejection: a case report.BMC ophthalmology · 2023Article
- Searching for new antifungals for the treatment of cryptococcosis.Revista da Sociedade Brasileira de Medicina Tropical · 2023Review
- Review
- Raman Study of PathogenicFrontiers in microbiology · 2022Article
- Combination Therapy for HIV-Associated Cryptococcal Meningitis-A Success Story.Journal of fungi (Basel, Switzerland) · 2021Review
- Cryptococcus neoformans infection in Human Immunodeficiency Virus (HIV)-infected and HIV-uninfected patients at an inner-city tertiary care hospital in the Bronx.Medical mycology · 2020Article
- Cryptococcal-related Mortality Despite Fluconazole Preemptive Treatment in a Cryptococcal Antigen Screen-and-Treat Program.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2020Article
- Interactions of FK506 and Rapamycin With FK506 Binding Protein 12 in Opportunistic Human Fungal Pathogens.Frontiers in molecular biosciences · 2020Review
- Mortality After Cryptococcal Infection in the Modern Antiretroviral Therapy Era.Journal of acquired immune deficiency syndromes (1999) · 2019Article
- Central Nervous System Cryptococcal Infections in Non-HIV Infected Patients.Journal of fungi (Basel, Switzerland) · 2019Review
- Efficacy of Oral Encochleated Amphotericin B in a Mouse Model of Cryptococcal Meningoencephalitis.mBio · 2019Article
- CRYPTOCOCCAL meningitis in a HIV negative newly diagnosed diabetic patient: a CASE report.BMC infectious diseases · 2019Article
- EQUALOpen forum infectious diseases · 2018Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe Infectious Diseases Society of America published in 2000 practical guidelines for the management of cryptococcosis. However, treatment strategies have not been fully validated in the various clinical settings due to exclusion criteria during therapeutic trials. We assessed here the optimal therapeutic strategies for severe cryptococcosis using the observational prospective CryptoA/D study after analyzing routine clinical care of cryptococcosis in university or tertiary care hospitals. METHODOLOGY/PRINCIPAL
findingsPatients were enrolled if at least one culture grew positive with Cryptococcus neoformans. Control of sterilization was warranted 2 weeks (Wk2) and 3 months (Mo3) after antifungal therapy onset. 208 HIV-positive or -negative adult patients were analyzed. Treatment failure (death or mycological failure) at Wk2 and Mo3 was the main outcome measured. Combination of amphotericin B+flucytosine (AMB+5FC) was the best regimen for induction therapy in patients with meningoencephalitis and in all patients with high fungal burden and abnormal neurology. In those patients, treatment failure at Wk2 was 26% in the AMB+5FC group vs. 56% with any other treatments (p<0.001). In patients treated with AMB+5FC, factors independently associated with Wk2 mycological failure were high serum antigen titer (OR [95%CI] = 4.43[1.21-16.23], p = 0.025) and abnormal brain imaging (OR = 3.89[1.23-12.31], p = 0.021) at baseline. Haematological malignancy (OR = 4.02[1.32-12.25], p = 0.015), abnormal neurology at baseline (OR = 2.71[1.10-6.69], p = 0.030) and prescription of 5FC for less than 14 days (OR = 3.30[1.12-9.70], p = 0.030) were independently associated with treatment failure at Mo3. CONCLUSION/SIGNIFICANCE: Our results support the conclusion that induction therapy with AMB+5FC for at least 14 days should be prescribed rather than any other induction treatments in all patients with high fungal burden at baseline regardless of their HIV serostatus and of the presence of proven meningoencephalitis.
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