Antifungal therapy for treatment of cryptococcal meningitis

Objective To compare the curative effects of three different antifungal reg imens in the treatment of cryptococcal meningitis. Methods Twenty-two patients were divided into 3 groups: Group I was given i ntravenous amphotericin B alone or combination with flucytosine therapy. Gr oup II: received intravenous fluconazole alone or combination with flucytos ine. The treatment of Group III was divided into two steps, where the patie nts received intrathecal amphotericin B plus intravenous amphotericin B wit h or without intravenous fluconazole until the mycological culture of cereb rospinal fluid (CSF) turned negative, followed by oral fluconazole or itrac onazole as maintenance therapy until direct microscopic examination of CSF showed negative once a week for three consecutive weeks. Results Of the twenty-two patients, 17 (77.3%) were cured, 2 (9.1%) improve d, 3 (13.6%) died, and one (4.5%) relapsed. Of the 8 patients in Group I, 5 were cured, 2 improved, one died and one relapsed; Of the 4 patients in Gr oup II, 2 were cured, and 2 died; All the 10 patients in Group III were cur ed without any recurrence. Conclusion The two-step therapeutic regimen may be suited to the treatment of cryptococcal meningitis.