Fluconazole compared with amphotericin B plus flucytosine for cryptococcal meningitis in AIDS: a randomized trial

Article Abstract:

Cryptococcal meningitis is an infection that occurs in approximately 10 percent of patients with acquired immunodeficiency syndrome (AIDS). It is a serious infection and results in death in nearly 60 percent of these patients. Amphotericin B and flucytosine are antifungal agents that can be used either alone or in combination to treat cryptococcal meningitis. A new antifungal agent, fluconazole, was evaluated for the treatment of infections caused by the fungus Cryptococcus neoformans. Fluconazole was compared with the combination antifungal regimen of amphotericin B and flucytosine. Fourteen patients received fluconazole, while the remainder received the combination therapy. Conversion of blood, urine, and cerebrospinal fluid cultures from positive to negative was the anticipated indication of successful treatment. Success was slower in patients receiving fluconazole than among those receiving amphotericin B. In seven of nine patients treated with fluconazole, cerebrospinal fluid cultures did not convert to negative. Overall, patients with less severe disease responded better to therapy. Fluconazole was well tolerated, while amphotericin B therapy was associated with nausea, vomiting, and chills, side effects commonly experienced with use of this drug. The investigators did not expect fluconazole to result in treatment failure. Although this drug has some effectiveness against cryptococci, higher doses may be required or it may need to be combined with flucytosine. An alternate regimen may be an initial short course of treatment with the successful combination of amphotericin B and flucytosine followed by treatment with fluconazole. This study did not establish fluconazole as an effective, nontoxic alternative to other antifungals. (Consumer Summary produced by Reliance Medical Information, Inc.)

Antifungal agents, Cryptococcus

---

Fluconazole, a new antifungal agent

Article Abstract:

The new antifungal agent fluconazole was approved by the Food and Drug Administration (FDA) earlier this year. In humans, it is indicated for the treatment of fungal infections due to cryptococcal and candida fungi, while experience in animals demonstrated it to be effective for coccidioidomycosis, histoplasmosis, blastomycosis, and aspergillosis. An article in the August 1, 1990 issue of Annals of Internal Medicine describes a comparative study of fluconazole versus the combination of amphotericin B and flucytosine for the treatment of cryptococcal meningitis. Investigators hoped that this drug would be a useful replacement for other, more toxic antifungal agents, since initial reports of patients with acquired immunodeficiency syndrome (AIDS) were very encouraging. Conversion of cerebrospinal cultures was lower in patients who received fluconazole than among those given the combination treatment, and a higher death rate occurred. Aggressive therapy with amphotericin B and flucytosine is the preferred treatment regimen. Nevertheless, patients with cryptococcal meningitis and AIDS will require maintenance antifungal therapy and fluconazole may be useful for that purpose. Fluconazole may also be used for oral candida (thrush) infections in AIDS patients or patients receiving chemotherapy. Continued study of this new drug is needed to determine its effectiveness for the treatment of invasive systemic fungal diseases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social policy, Diseases, AIDS patients, Candidiasis, United States. Food and Drug Administration, editorial

---

Fluconazole therapy for coccidioidal meningitis

Article Abstract:

Fluconazole may be an effective and safe treatment for patients with coccidioidal meningitis. Coccidioidal meningitis is inflammation of the membranes of the brain or spinal cord caused by infection with Coccidioides immitis. Forty-seven patients with coccidioidal meningitis were treated with 400 milligrams of fluconazole per day for an average of three years. Twenty-three patients had had no previous treatment, and eight were infected with HIV. Seventy-nine percent of the patients improved after treatment with fluconazole. No significant difference in response occurred between the patients who had previously been treated and those who had not. Infection with HIV also did not affect response to treatment with fluconazole. Two patients developed confusion after treatment with fluconazole, but this side effect disappeared after their dosage was reduced. No other serious side effect occurred.

Health aspects, Coccidioides immitis, Ascomycota

Similar abstracts:

• Abstracts: Prophylactic amnioinfusion as a treatment for oligohydramnios in laboring patients: a prospective, randomized trial
• Abstracts: Interferon-alpha with asymptomatic human immunodeficiency virus (HIV) infection: a randomized, placebo-controlled trial. part 2
• Abstracts: Aerosol pentamidine for secondary prophylaxis of AIDS-related Pneumocystis carinii pneumonia: a randomized, placebo-controlled study
• Abstracts: Impact of the human immunodeficiency virus epidemic on mortality in women of reproductive age, United States. part 2
• Abstracts: Human recombinant DNA-derived antihemophilic factor (factor VIII) in the treatment of hemophilia. Recombinant factor VIII for the treatment of previously untreated patients with hemophilia A: safety, efficacy, and development of inhibitors

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.