Recommendations
| Дозування | Ремарки | |
|---|---|---|
|
1st choice
|
liposomal amphotericin B (Ambisome) IV 3 mg/kg once daily for at least 2 weeks
+ flucytosine IV 25 mg/kg four times daily for at least 2 weeks |
Induction therapy |
| Дозування | Ремарки | |
|---|---|---|
|
2nd choice
|
liposomal amphotericin B (Ambisome) IV 3 mg/kg once daily for at least 2 weeks
+ fluconazole oral loading dose 800 mg, then 400 mg twice daily for at least 2 weeks |
Induction therapy in case of intolerance to or contraindication for flucytosine |
| Дозування | Ремарки | |
|---|---|---|
|
fluconazole oral loading dose 800 mg, then 400 mg once daily for at least 8 weeks
|
Consolidation therapy. In a stable patient with a good clinical response after 2 weeks |
| Дозування | Ремарки | |
|---|---|---|
|
As for cryptococcal meningitis
|
| Дозування | Ремарки | |
|---|---|---|
|
oral loading dose 800 mg, then 400 mg once daily
|
Treatment duration 6 weeks–6 months guided by resolution of infection. |
Secondary prophylaxis: in HIV, continue until CD4 is >100 cells/mm3 for ≥3 months and the HIV viral load is undetectable.
NB. Therapeutic drug monitoring is required during treatment with flucytosine.
Flucytosine is contraindicated in patients with dihydropyrimidine dehydrogenase (DPD) deficiency. However, pre-testing is not necessary given the rarity of this deficiency.