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Original ArticleOpen Access
The Efficacy of Fluconazole 600 mg/day versus Itraconazole 600 mg/day as Consolidation Therapy of Cryptococcal Meningitis in AIDS Patients
Mootsikapun P 
,
Chetchotisakd P ,
Anunnatsiri S ,
Choksawadphinyo K
,
Chetchotisakd P ,
Anunnatsiri S ,
Choksawadphinyo K Cryptococcal meningitis is one of the major complications affecting the central nervous system
of patients suffering from AIDS. The results of treatment, when following current recommendation
are still unsatisfactory.
Objective : This study aimed to evaluate the efficacy of a higher than recommended dose
of oral fluconazole and itraconazole as consolidation therapy for cryptococcal meningitis in AIDS
patients.
Design and Method : HIV infected patients with primary cryptococcal meningitis, who had
been treated initially with amphotericin B for 2 weeks were included in this study. They were randomized
into two groups, to receive either fluconazole 600 mg daily or itraconazole 600 mg daily for
10 weeks. The response towards the two different treatments was clinically defined to be successful,
if after 10 weeks of treatment no clinical symptoms and signs of meningitis remained and the
cerebrospinal fluid (CSF) fungal culture was negative.
Results : The trial was performed from April 1999 to April 2000 at Srinagarind Hospital,
Khon Kaen, Thailand. At the beginning of the trial 44 cases were selected, but only 35 patients proved
to be suitable for the final evaluation of the study. Out of those, 19 cases were assigned to the fluconazole
and 16 cases to the itraconazole group. Ten weeks after treatment, all patients clinically
recovered completely. The CSF sterilization rate for the fluconazole group and for the itraconazole
group were 100 and 94 per cent respectively. The Fisher's exact test showed no significant difference
in the CSF sterilization rate between both groups (p = 0.26).
Conclusion : The result of this study indicates that treatment with either 600 mg per day
of fluconazole or itraconazole as consolidation treatment have the same efficacy for AIDS patients
suffering from cryptococcal meningitis. The results of this study also suggest, comparing the result of
this trial with the results of similar trials published somewhere else, that treatment with the higher
doses may be superior to treatment regimens using lower doses, as can be judged from the clinical
outcome and the results of the mycological cultures.
Key word : Fluconazole, Itraconazole, Cryptococcal Meningitis, AIDS
of patients suffering from AIDS. The results of treatment, when following current recommendation
are still unsatisfactory.
Objective : This study aimed to evaluate the efficacy of a higher than recommended dose
of oral fluconazole and itraconazole as consolidation therapy for cryptococcal meningitis in AIDS
patients.
Design and Method : HIV infected patients with primary cryptococcal meningitis, who had
been treated initially with amphotericin B for 2 weeks were included in this study. They were randomized
into two groups, to receive either fluconazole 600 mg daily or itraconazole 600 mg daily for
10 weeks. The response towards the two different treatments was clinically defined to be successful,
if after 10 weeks of treatment no clinical symptoms and signs of meningitis remained and the
cerebrospinal fluid (CSF) fungal culture was negative.
Results : The trial was performed from April 1999 to April 2000 at Srinagarind Hospital,
Khon Kaen, Thailand. At the beginning of the trial 44 cases were selected, but only 35 patients proved
to be suitable for the final evaluation of the study. Out of those, 19 cases were assigned to the fluconazole
and 16 cases to the itraconazole group. Ten weeks after treatment, all patients clinically
recovered completely. The CSF sterilization rate for the fluconazole group and for the itraconazole
group were 100 and 94 per cent respectively. The Fisher's exact test showed no significant difference
in the CSF sterilization rate between both groups (p = 0.26).
Conclusion : The result of this study indicates that treatment with either 600 mg per day
of fluconazole or itraconazole as consolidation treatment have the same efficacy for AIDS patients
suffering from cryptococcal meningitis. The results of this study also suggest, comparing the result of
this trial with the results of similar trials published somewhere else, that treatment with the higher
doses may be superior to treatment regimens using lower doses, as can be judged from the clinical
outcome and the results of the mycological cultures.
Key word : Fluconazole, Itraconazole, Cryptococcal Meningitis, AIDS
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