Triple therapy versus amphotericin B plus flucytosine for the treatment of non-HIV- and non-transplant-associated cryptococcal meningitis: retrospective cohort study

氟胞嘧啶 医学 两性霉素B 内科学 氟康唑 养生 不利影响 隐球菌病 脑膜炎 胃肠病学 外科 免疫学 抗真菌 皮肤病科
作者
Li Xu,Jia Liu,Qilong Zhang,Min Li,Jingchi Liao,Weifeng Kuang,Cansheng Zhu,Huan Yi,Fuhua Peng
出处
期刊:Neurological Research [Taylor & Francis]
卷期号:40 (5): 398-404 被引量:16
标识
DOI:10.1080/01616412.2018.1447319
摘要

ObjectivesAmphotericin B plus flucytosine is the most widely used induction therapy regimen for non-HIV-infected and non-transplant patients; however, the therapeutic outcomes are unsatisfactory, especially when two antifungal drugs are at sub-therapeutic doses.MethodsIn this study of induction therapy, all non-HIV-infected, non-transplant patients with a first episode of cryptococcal meningitis were divided into two groups. In group I, the patients received amphotericin B plus 5-flucytosine. In group II, in addition to amphotericin B and 5-flucytosine, the patients also received fluconazole.ResultsIn this study, 32 patients were included in group I, and the other 30 were in group II. Although patients from group II had higher fungal burdens with approximately 2100 Cryptococci/ml CSF before treatment, they had a significantly higher frequency of satisfactory outcomes (80% vs. 50%, respectively, P = 0.014). Less time for more patients in group II to have CSF sterilization (P = 0.021; P = 0.046). And more patients in group II had improved neurological function circumstances evaluated by comparing the BMRC staging between patients at discharge and follow-up 10 weeks (P = 0.032). No significant difference was observed in the incidence of adverse events between the two groups.ConclusionTriple therapy a superior alternative induction regimen for patients with non-HIV- and non-transplant-associated cryptococcal meningitis.

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