Cryoptococcal meningitis

January 2007     View PDF     En español

Other treatments

Because people who take amphotericin B often experience severe side effects, other formulations of this medication are approved for use in cryptococcal meningitis and are increasingly being used. The newer medications are a special formulation of amphotericin, which is liposomally encapsulated. Liposomal drugs are those that have an active drug like amphotericin B inserted into a liposome (a fat bubble). The liposome slows down the process by which the body breaks down and eliminates the active drug, allowing lower doses to be used. This can result in fewer side effects. For cryptococcal meningitis, those liposomal drugs include Amphotec, Ambisome and Abelcet.

Upon reviewing data from the studies of Ambisome in particular, many believe that, because Ambisome causes fewer side effects, it may be superior to standard amphotericin B as first line therapy for cryptococcal meningitis. Ambisome is recommended for patients with kidney problems or who can not tolerate amphotericin B.

However, a recent survey of experts on the treatment of cryptococcal meningitis indicates otherwise. Based on their interpretation of study results, combined with their extensive clinical experience treating cryptococcal meningitis, they do not find evidence to suggest that any of the liposomal drugs are significantly more effective or less toxic than standard amphotericin B. Their recommendation for first line therapy remains consistent with the current federal guidelines stated above. They do however, believe the liposomal drug Ambisome to be superior to Abelcet or Amphotec, and they do recommend its use when patients have kidney problems or cannot tolerate amphotericin B.