Practice Guidelines for the Management of Cryptococcal Disease

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2000
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Abstract
An 8-person subcommittee of the National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group evaluated available data on the treatment of cryptococcal disease.Opinion regarding optimal treatment was based on personal experience and information in the literature.The relative strength of each recommendation was graded according to the type and degree of evidence available to support the recommendation, in keeping with previously published guidelines by the Infectious Diseases Society of America (IDSA).The panel conferred in person (on 2 occasions), by conference call, and through written reviews of each draft of the manuscript.The choice of treatment for disease caused by Cryptococcus neoformans depends on both the anatomic sites of involvement and the host's immune status.For immunocompetent hosts with isolated pulmonary disease, careful observation may be warranted; in the case of symptomatic infection, indicated treatment is fluconazole, 200-400 mg/day for 3-6 months.For those individuals with non-CNS-isolated cryptococcemia, a positive serum cryptococcal antigen titer 11 : 8, or urinary tract or cutaneous disease, recommended treatment is oral azole therapy (fluconazole) for 3-6 months.In each case, careful assessment of the CNS is required to rule out occult meningitis.For those individuals who are unable to tolerate fluconazole, itraconazole (200-400 mg/day for 6-12 months) is an acceptable alternative.For patients with more severe disease, treatment with amphotericin B (0.5-1 mg/kg/d) may be necessary for 6-10 weeks.For otherwise healthy hosts with CNS disease, standard therapy consists of amphotericin B, 0.7-1 mg/kg/d, plus flucytosine, 100 mg/kg/d, for 6-10 weeks.An alternative to this regimen is amphotericin B (0.7-1 mg/kg/d) plus 5-flucytosine (100 mg/kg/d) for 2 weeks, followed by fluconazole (400 mg/day) for a minimum of 10 weeks.Fluconazole "consolidation" therapy may be continued for as along as 6-12 months, depending on the clinical status of the patient.HIV-negative, immunocomprom-
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Authors M. S. Saag, Richard Graybill, Robert A. Larsen, P. G. Pappas, John R. Perfect, William G. Powderly, Jack D. Sobel, William E. Dismukes
Journal Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
Year 2000
DOI
10.1086/313757
URL
https://academic.oup.com/cid/article-pdf/30/4/710/1170526/30-4-710.pdf
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