Combination Versus Monotherapy for the Treatment of HIV Associated Cryptococcal Meningitis
Published: February 1, 2015 | DOI: https://doi.org/10.7860/JCDR/2015/.5601
Shashank Anant Vaidhya, Bharat Bhushan Gupta, Rajesh Kumar Jha, Ravindra Kumar
1. Associate Professor, Department of Medicine, Sri Aurobindo Medical College and PG Insitute, Indore, India.
2. Associate Professor, Department of Medicine, Sri Aurobindo Medical College and PG Insitute, Indore, India.
3. Professor and Head, Department of Medicine, Sri Aurobindo Medical College and PG Insitute, Indore, India.
4. Scientist, Central Research Laboratory, Sri Aurobindo Medical College and PG Insitute, Indore, India.
Correspondence
Dr. Rajesh Kumar Jha,
Professor and Head, Department of Medicine, Sri Aurobindo Medical College and PG Institute Indore,
Ujjain Highway, Indore, Madhya Pradesh, India.
E-mail : dr_rkjha_02@yahoo.co.in, ravindrachhabra@gmail.com
Objective: To study the efficacy of anti Cryptococcal treatment by cerebrospinal fluid (CSF) fungal negativity after two weeks of treatment with amphotericin B alone or combined with fluconazole in treatment of HIV associated Cryptococcal meningitis (CM).
Materials and Methods: A total of 84 human immunodeficiency virus (HIV) associated CM patients confirmed by CSF culture positivity were recruited for the study. Patients were randomly divided into two groups. Group A was given amphotericin B alone whereas Amphotericin B in combination with fluconazole was given in group B for the treatment of CM. Patients were followed for 14 days.
Results: Maximum number of patients was in the age group 21-49 y. All the 84 patients had <100 CD4 counts/µl. After 14 days of the treatment in group A and B, there was no significant difference in terms of fever, headache and neck stiffness as a clinical outcome. But in group B there was improved in altered sensorium and focal neurological deficit as compared to group A. After 14 days of the treatment CSF culture negativity was more in group B as compared to group A.
Conclusion: Amphotericin B in combination with fluconazole is recommended for the treatment of HIV associated CM.
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