Voriconazole plus flucytosine is not superior to amphotericin B deoxycholate plus flucytosine as an induction regimen for cryptococcal meningitis treatment

氟胞嘧啶 两性霉素B 养生 医学 内科学 肌酐 两性霉素B脱氧胆酸盐 胃肠病学 肾功能 隐球菌病 卡斯波芬金 免疫学 抗真菌 皮肤病科
作者
Handan Zhao,Yanqiu Lu,Shan Li,Jiangying Qin,Miaomiao Xu,Hui Ye,Zongxing Yang,Jianfeng Rao,Guochun Chen,Feifei Su,Zhiliang Hu,Lijun Xu
出处
期刊:Mycoses [Wiley]
卷期号:67 (1) 被引量:1
标识
DOI:10.1111/myc.13674
摘要

Abstract Background The efficacy and side effects of voriconazole plus 5‐flucytosine (Vori + 5‐FC) versus amphotericin B deoxycholate plus 5‐flucytosine (AmBd + 5‐FC) as an induction treatment for cryptococcal meningitis are unknown. Methods Forty‐seven patients treated with Vori + 5‐FC and 92 patients treated with AmBd + 5‐FC were included in the current study after propensity score matching (PSM) at a ratio of 1:2. Two‐week laboratory test results and 90‐day mortality were compared between the two groups. Results After 2 weeks of induction treatment, the CSF Cryptococcus sterile culture rate was 57.1% in the Vori + 5‐FC group and 76.5% in the AmBd + 5‐FC group ( p = .026). No difference was found in the normalization of CSF indicators (glucose, total protein, intracranial pressure and India ink sterile rate) between the two groups. Both the Vori + 5FC regimen and AmBd + 5‐FC regimen obviously decreased haemoglobin concentrations, platelet counts and serum potassium levels (all p ≤ .010). Notably, the Vori + 5FC regimen did not influence serum creatinine levels ( p = .263), while AmBd + 5FC increased serum creatinine levels ( p = .019) after 2‐week induction treatment. The Vori + 5‐FC group and AmBd + 5‐FC group had similar 90‐day cumulative survival rates (89.9% vs. 87.8%, p = .926). Conclusion The Vori + 5‐FC regimen was associated with low 2‐week CSF sterile culture and was not superior to AmBd + 5‐FC as induction therapy in terms of the 90‐day cumulative survival rate of CM patients.
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