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Day, Jeremy N; Chau, Tran T.H; Wolbers, Marcel; Mai, Pham P; Dung, Nguyen T; Mai, Nguyen H; Phu, Nguyen H; Nghia, Ho D; Phong, Nguyen D; Thai, Cao Q; Thai, Le H; Chuong, Ly V; Sinh, Dinh X; Duong, Van A; Hoang, Thu N; Diep, Pham T; Campbell, James I; Sieu, Tran P.M; Baker, Stephen G; Chau, Nguyen V.V; Hien, Tran T; Lalloo, David G; Farrar, Jeremy J
The New England journal of medicine, 04/2013, Volume: 368, Issue: 14Journal Article
Determining the best therapy for HIV-associated cryptococcal meningitis in resource-poor settings is controversial. In this trial in Vietnam, initial therapy with amphotericin B with flucytosine had better outcomes than amphotericin B alone or with fluconazole. There are approximately 1 million cases of cryptococcal meningitis annually and 625,000 deaths. 1 Treatment guidelines recommend induction therapy with amphotericin B deoxycholate (0.7 to 1 mg per kilogram of body weight per day) and flucytosine (100 mg per kilogram per day). 2 However, this treatment has not been shown to reduce mortality, as compared with amphotericin B monotherapy. 2 , 3 Flucytosine is frequently unavailable where the disease burden is greatest, and concerns about cost and side effects have limited its use in resource-poor settings. 4 Fluconazole is readily available, is associated with low rates of adverse events, and has good penetration into cerebrospinal . . .
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