COMPARISON OF THE EFFICACY OF AMPHOTERICIN-B AND FLUCONAZOLE IN THE TREATMENT OF CRYPTOCOCCOSIS IN HUMAN-IMMUNODEFICIENCY-VIRUS-NEGATIVE PATIENTS - RETROSPECTIVE ANALYSIS OF 83 CASES

We retrospectively analyzed clinical outcome of meningeal and extramen ingeal cryptococcosis in HIV-negative patients treated with amphoteric in B (43 patients) or fluconazole (40 patients), Amphotericin B and fl uconazole were prescribed equally to patients with neoplastic diseases and no risk factor, but organ transplant recipients and patients with other diseases were mostly given fluconazole and amphotericin B, resp ectively. Patients with more severe infections (i.e., meningitis, neur ological disorders, or higher levels of antigen in cerebrospinal fluid ) were more frequently treated with amphotericin B. A cure rate of >70 % was achieved regardless of the initial treatment and the severity of the infection, A Cox regression analysis showed that age of >60 years , neoplastic disease, abnormal mental status, disseminated infection a t the time of diagnosis, and therapeutic failure were independent pred ictors of death. Although fluconazole appears to be as effective as am photericin B, only a prospective multicenter study will determine the best treatment regimen for patients with cryptococcal meningitis who d o not have AIDS.