Cryoptococcal meningitis

January 2007     View PDF     En español

Moderate to severe meningitis

For more severe cases of cryptococcal meningitis, the current treatment of choice is a combination of the intravenous (IV) drug amphotericin B (AmB, Fungizone) and flucytosine (Ancobon) in pill form. This combination is given daily until the CSF is sterile (contains no Cryptococcus), usually for two to four weeks. Most people are then switched to fluconazole for eight weeks. Following a moderate-to-severe case of meningitis, the chance of relapse after treatment is extremely high. Therefore, most physicians recommend that people continue to take fluconazole daily for the rest of their lives, even after completing a successful course of treatment.

Effective treatment for cryptococcal meningitis is still possible, however, for those who have become resistant to fluconazole. If an individual is known or suspected to have Cryptococcus that is resistant to fluconazole, it may be possible to substitute itraconazole (Sporanox). As with the course of treatment mentioned above, mild meningitis may be treated with itraconazole at a dose of 200mg three times per day for three days. On the fourth day, the dose is lowered to 200mg twice per day for six to ten weeks. For more severe meningitis, amphotericin B should be used in combination with flucytosine until the CSF is sterile or for at least two weeks. Itraconazole is then recommended at a dose of 200mg twice per day for life.