Evaluation of amphotericin B deoxycholate(AmB-D)combined with flucytosine for induction therapy in AIDS patients with cryptococcal meningitis
ZHU Keyang
LU Yanqiu
WANG Dengping
CHEN Yaokai
Abstract：Objective To investigate the efficacy and safety of using fluconazole as an additional therapeutic modality during the smphotericin B deoxycholate(AmB-D)dosage escalation phase in patients with AIDS-associated cryptococcal meningitis(AIDS/CM).Methods A retrospective study of clinical data was conducted in hospitalized AIDS/CM patients at the Chongqing Public Health Medical Center.Enrolled patients were stratified into the no-fluconazole addition group and the flu-conazole addition group based on whether fluconazole was added or not during the AmB-D dosage escalation phase.The two groups were compared in terms of cerebrospinal fluid(CSF)routine data and biochemical parameters,cryptococcal clearance rate and time to fungal clearance,proportion of treatment discontinuation due to severe adverse events,in-hospital mortality rate,and cumulative survival rate after discharge.Results Between January 1,2018,and June 30,2023,a total of 307 AIDS/CM patients were hospitalized for treatment at the center.Amongst them,199 patients received AmB-D plus flucy-tosine as their induction antifungal regimen.Of these 199 patients,151 patients were stratified into the no-fluconazole addi-tion group and 48 patients in the fluconazole addition group.After 1 or 2 weeks of antifungal treatment,there were no sta-tistically differences between the two groups in terms of changes in CSF routine data and biochemical parameters,cryptococ-cal clearance rate,or time to fungal clearance.Additionally,there were no differences in the incidence of adverse reactions,in-hospital mortality,length of hospital stay,or cumulative survival rate after discharge between the two groups.However,the proportion of treatment discontinuation due to renal insufficiency was higher in the fluconazole addition group compared to the no-fluconazole addition group(10.4%vs.4.0%,P=0.039).Conclusion Addition of fluconazole during the AmB-D dosage escalation phase does not enhance antifungal efficacy or improve long-term survival in AIDS/CM patients receiving AmB-D plus flucytosine as their induction antifungal regimen.Instead,addition of fluconazole to the induction regimens of these patients increases the risk of treatment discontinuation due to adverse events.
Keywords：amphotericin B deoxycholatefluconazoleAIDScryptococcal meningitisclinical efficacysafety
Publication Date：2025-04-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 131-135,147 )