Trial reportAntimicrobial agents and chemotherapy2015
Increased Antifungal Drug Resistance in Clinical Isolates of Cryptococcus neoformans in Uganda.
Trial report in Antimicrobial agents and chemotherapy, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01802385 (Adjunctive Sertraline for the Treatment of HIV-Associated Cryptococcal Meningitis), which is not on this map. Cited by 109 papers, 3 of them syntheses that pooled it.
What it found
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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.
Adjunctive Sertraline for the Treatment of HIV-Associated Cryptococcal Meningitis
Who cites it
109 citing papers in PubMed, 3 syntheses or guidelines pooled it, 187 citations in OpenAlex.
- Global guideline for the diagnosis and management of cryptococcosis: an initiative of the ECMM and ISHAM in cooperation with the ASM.The Lancet. Infectious diseases · 2024Guideline
- Cryptococcosis-a systematic review to inform the World Health Organization Fungal Priority Pathogens List.Medical mycology · 2024Pooled it
- Pulmonary cryptococcosis complicated with pulmonary aspergillosis: a series of studies and a literature review.BMC infectious diseases · 2024Pooled it
- Adjunctive sertraline for asymptomatic cryptococcal antigenemia: A randomized clinical trial.Medical mycology · 2020Trial
- Adjunctive sertraline for HIV-associated cryptococcal meningitis: a randomised, placebo-controlled, double-blind phase 3 trial.The Lancet. Infectious diseases · 2019Trial
- Trial
- Efficacy of adjunctive sertraline for the treatment of HIV-associated cryptococcal meningitis: an open-label dose-ranging study.The Lancet. Infectious diseases · 2016Trial
- An Organoselenium Compound Induces Death inACS omega · 2026Article
- A review of the current anti-New microbes and new infections · 2026Review
- Targeting Yeast Pathogens with Lectins: A Narrative Review from Mechanistic Insights to the Need for Addressing Translational Challenges.Biomedicines · 2026Review
- Towards understanding a potentialOne health (Amsterdam, Netherlands) · 2025Article
- Regulatory gaps in over-the-counter antifungal access for vulvovaginal candidiasis in Uganda: A policy analysis framework.IJID regions · 2025Article
- Assessing the Anti-Cryptococcus Antifungal Potential of Artemisinin.International journal of molecular sciences · 2025Article
- Therapeutic Repurposing of Sertraline: Evidence for Its Antifungal Activity from In Vitro, In Vivo, and Clinical Studies.Microorganisms · 2025Review
- InFuture microbiology · 2025Article
- Genomic Characterization ofVeterinary sciences · 2025Article
- Review
- Comparative evaluation of sensititre YeastOne and VITEK2 antifungal susceptibility tests with CLSI broth microdilution method of clinicalMicrobiology spectrum · 2025Article
- Yeast-secreted compounds with antifungal activity-screening, genetic parts, biosynthetic pathways, and regulation.FEMS yeast research · 2025Review
- Fluconazole Resistance and Heteroresistance in Cryptococcus spp.: Mechanisms and Implications.Revista da Sociedade Brasileira de Medicina Tropical · 2025Review
49 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
12 authors at 5 institutions in 2 countries.
Funding
Abstract
Cryptococcal antigen screening is recommended among people living with AIDS when entering HIV care with a CD4 count of <100 cells/μl, and preemptive fluconazole monotherapy treatment is recommended for those with subclinical cryptococcal antigenemia. Yet, knowledge is limited of current antimicrobial resistance in Africa. We examined antifungal drug susceptibility in 198 clinical isolates collected from Kampala, Uganda, between 2010 and 2014 using the CLSI broth microdilution assay. In comparison with two previous studies from 1998 to 1999 that reported an MIC50 of 4 μg/ml and an MIC90 of 8 μg/ml prior to widespread human fluconazole and agricultural azole fungicide usage, we report an upward shift in the fluconazole MIC50 to 8 μg/ml and an MIC90 value of 32 μg/ml, with 31% of isolates with a fluconazole MIC of ≥ 16 μg/ml. We observed an amphotericin B MIC50 of 0.5 μg/ml and an MIC90 of 1 μg/ml, of which 99.5% of isolates (197 of 198 isolates) were still susceptible. No correlation between MIC and clinical outcome was observed in the context of amphotericin B and fluconazole combination induction therapy. We also analyzed Cryptococcus susceptibility to sertraline, with an MIC50 of 4 μg/ml, suggesting that sertraline is a promising oral, low-cost, available, novel medication and a possible alternative to fluconazole. Although the CLSI broth microdilution assay is ideal to standardize results, limit human bias, and increase assay capacity, such assays are often inaccessible in low-income countries. Thus, we also developed and validated an assay that could easily be implemented in a resource-limited setting, with similar susceptibility results (P = 0.52).
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.