Comparison of One Week with Two Week Regimens of Amphotericin B Both followed by Fluconazole in the Treatment of Cryptococcal Meningitis among AIDS Patients
Somsit Tansuphaswadikul MD*, Wirach Maek-a-Nantawat MD**, Benjaluck Phonrat MSc**, Lamom Boonpok BN*, Aneley Getahun MCTM**, Punnee Pitisuttithum MD**
Affiliation : * Bamrasnaradura Infectious Disease Institute, Department of Disease Control, Nonthaburi ** Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University
Background : Amphotericin B treatment in cryptococcosis requires daily hospital visits or admission. Its
toxicities and hospital costs have been concerned. Short course amphotericin B regimen warrants to be
evaluated.
Objective : To compare the safety and efficacy of one-week (AmB1) with two-week (AmB2) amphotericin B both
followed by fluconazole.
Materials and Methods : 57 AIDS with cryptococcal meningitis were randomly assigned to either AmB1 or
AmB2. Microbiological and clinical clearances were the outcomes of the study.
Results : The treatment success at 6 weeks was 63.3% in AmB1 and 70.4% in AmB2 (p = 0.574). Clinical
assessment at week 10 and renal toxicities were not significantly different between both regimens. Mortality
rate was 14% however, 75% of deaths were in AmB2.
Conclusion : AmB1 was comparably effective and safe as the standard AmB2 regimen in the treatment of AIDS
related cryptococcal meningitis. It can be an alternative regimen to lower hospital based care and improve
cost effective for source limiting health care centers.
Keywords : Cryptococcal meningitis, AIDS, Amphotericin B, Thailand
