Summary Objectives: To describe the mycologic and clinical outcomes and factors associated
with failure in Peruvian patients with AIDS-associated cryptococcal meningitis (CM)
treated with amphotericin B deoxycholate (Amph B) followed by fluconazole.
Methods: Patients were treated with intravenous Amph B 0.7 mg/kg/day for 2 or 3 weeks
followed by oral fluconazole 400 mg/day for 7 or 8 weeks. Clinical and laboratory evaluations
including cerebrospinal fluid (CSF) studies were performed at baseline and at weeks 2 and 10.
Results: The CSF cultures were negative in 25% and 68% of 47 patients at weeks 2 and 10, respectively.
In the univariate analysis, baseline low body mass index (BMI), hyponatremia, low
serum albumin, positive blood culture and CSF antigen titers 1024 were associated with a positive
CSF culture at week 2. Baseline positive urine culture, positive blood culture, any positive
extraneural culture and CSF opening pressure at week 2 300 mm H2O were associated with
a positive CSF culture at week 10. In the multivariate analysis no association was found.
Conclusions: Therapy with Amph B and fluconazole, combined with aggressive management of
elevated intracranial pressure (ICP), results in low CSF sterilization rates at week 2 and acceptable
CSF sterilization rates at week 10 when compared with other series.
ª 2008 The British Infection Society. Published by Elsevier Ltd. All rights reserved.