title: Combination therapy with fluconazole and flucytosine for cryptococcal meningitis in Ugandan patients with AIDS.
abstract: We performed a randomized trial in which combination therapy with fluconazole and short-term flucytosine was compared with fluconazole monotherapy in 58 patients with AIDS-associated cryptococcal meningitis (CM). Thirty of these patients were randomized to receive combination therapy with fluconazole, 200 mg once a day for 2 months, and flucytosine, 150 mg/(kg.d) for the first 2 weeks, and 28 were randomized to receive monotherapy with fluconazole at the same dose for 2 months. Patients in both groups who survived for 2 months received fluconazole as maintenance therapy at a dose of 200 mg three times per week for 4 months. The combination therapy prevented death within 2 weeks and significantly increased the survival rate among these patients (32%) at 6 months over that among patients receiving monotherapy (12%) (P = .022). The combination therapy also resulted in a significant decrease in the severity of headache after 1 month of treatment, compared with monotherapy (P = .005). No serious adverse reactions were observed in patients receiving either regimen. These data indicate that treatment with fluconazole and short-term flucytosine is a cost-effective and safe regimen that improves the quality of life for patients with AIDS-associated CM in developing countries where human immunodeficiency virus is endemic.
authors.affiliation: Department of Internal Medicine, Nagasaki University, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Mayanja-Kizza
authors.forename: K
authors.initials: K
authors.lastname: Oishi
authors.forename: S
authors.initials: S
authors.lastname: Mitarai
authors.forename: H
authors.initials: H
authors.lastname: Yamashita
authors.forename: K
authors.initials: K
authors.lastname: Nalongo
authors.forename: K
authors.initials: K
authors.lastname: Watanabe
authors.forename: T
authors.initials: T
authors.lastname: Izumi
authors.lastname: Ococi-Jungala
authors.forename: K
authors.initials: K
authors.lastname: Augustine
authors.forename: R
authors.initials: R
authors.lastname: Mugerwa
authors.forename: T
authors.initials: T
authors.lastname: Nagatake
authors.forename: K
authors.initials: K
authors.lastname: Matsumoto
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy*; D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage / Q000627:therapeutic use*; D005437:Flucytosine / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000188:drug therapy*; D008875:Middle Aged; D014454:Uganda
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole; D005437:Flucytosine