[HTML][HTML] A prospective study of mortality from cryptococcal meningitis following treatment induction with 1200mg oral fluconazole in Blantyre, Malawi
KM Gaskell, C Rothe, R Gnanadurai, P Goodson… - PloS one, 2014 - journals.plos.org
PloS one, 2014•journals.plos.org
Objective We have previously reported high ten-week mortality from cryptococcal meningitis
in Malawian adults following treatment-induction with 800mg oral fluconazole (57%[33/58]).
National guidelines in Malawi and other African countries now advocate an increased
induction dose of 1200mg. We assessed whether this has improved outcomes. Design This
was a prospective observational study of HIV-infected adults with cryptococcal meningitis
confirmed by diagnostic lumbar puncture. Treatment was with fluconazole 1200mg/day for …
in Malawian adults following treatment-induction with 800mg oral fluconazole (57%[33/58]).
National guidelines in Malawi and other African countries now advocate an increased
induction dose of 1200mg. We assessed whether this has improved outcomes. Design This
was a prospective observational study of HIV-infected adults with cryptococcal meningitis
confirmed by diagnostic lumbar puncture. Treatment was with fluconazole 1200mg/day for …
Objective
We have previously reported high ten-week mortality from cryptococcal meningitis in Malawian adults following treatment-induction with 800mg oral fluconazole (57% [33/58]). National guidelines in Malawi and other African countries now advocate an increased induction dose of 1200mg. We assessed whether this has improved outcomes.
Design
This was a prospective observational study of HIV-infected adults with cryptococcal meningitis confirmed by diagnostic lumbar puncture. Treatment was with fluconazole 1200mg/day for two weeks then 400mg/day for 8 weeks. Mortality within the first 10 weeks was the study end-point, and current results were compared with data from our prior patient cohort who started on fluconazole 800mg/day.
Results
47 participants received fluconazole monotherapy. Despite a treatment-induction dose of 1200mg, ten-week mortality remained 55% (26/47). This was no better than our previous study (Hazard Ratio [HR] of death on 1200mg vs. 800mg fluconazole: 1.29 (95% CI: 0.77–2.16, p = 0.332)). There was some evidence for improved survival in patients who had repeat lumbar punctures during early therapy to lower intracranial pressure (HR: 0.27 [95% CI: 0.07–1.03, p = 0.055]).
Conclusion
There remains an urgent need to identify more effective, affordable and deliverable regimens for cryptococcal meningitis.
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