A Comparison of Amphotericin B Alone and Combined with Flucytosine in the Treatment of Cryptoccal Meningitis

TLDR

The study compared amphotericin B alone to a combination of amphotericin B and flucytosine for treating cryptococcal meningitis. The trial enrolled 50 patients (51 treatment courses), with 27 receiving amphotericin B alone and 24 receiving the combination. The combination regimen cured or improved 16 patients versus 11 with amphotericin B alone, produced fewer failures or relapses (3 vs 11), achieved faster CSF sterilization, reduced nephrotoxicity, and had similar mortality, leading the authors to recommend it as the preferred treatment. N Engl J Med 301:126–131, 1979.

Abstract

We compared amphotericin B therapy for cryptococcal meningitis with a newer regimen containing both amphotericin B and flucytosine. In 50 patients with 51 courses of therapy adherent to the protocol, 27 courses were with amphotericin B and 24 with the combination. Even though the combination regimen was given for only six weeks and amphotericin B for 10 weeks, the combination cured or improved more patients (16 vs. 11), produced fewer failures or relapses (three vs. 11), more rapid sterilization of the cerebrospinal fluid (P<0.001) and less nephrotoxicity (P<0.05) than did amphotericin B alone. The number of deaths was the same (five) with each regimen. Adverse reactions to flucytosine occurred in 11 of 34 patients but were not life threatening. We conclude that combined flucytosine-amphoericin B therapy is the regimen of choice in cryptococcal meningitis. (N Engl J Med 301:126–131, 1979)