A comparison of itraconazole versus fluconazole as maintenance therapy for AIDS-associated cryptococcal meningitis. National Institute of Allergy and Infectious Diseases Mycoses Study Group

Clin Infect Dis. 1999 Feb;28(2):291-6. doi: 10.1086/515110.

Abstract

This study was designed to compare the effectiveness of fluconazole vs. itraconazole as maintenance therapy for AIDS-associated cryptococcal meningitis. HIV-infected patients who had been successfully treated (achieved negative culture of CSF) for a first episode of cryptococcal meningitis were randomized to receive fluconazole or itraconazole, both at 200 mg/d, for 12 months. The study was stopped prematurely on the recommendation of an independent Data Safety and Monitoring Board. At the time, 13 (23%) of 57 itraconazole recipients had experienced culture-positive relapse, compared with 2 relapses (4%) noted among 51 fluconazole recipients (P = .006). The factor best associated with relapse was the patient having not received flucytosine during the initial 2 weeks of primary treatment for cryptococcal disease (relative risk = 5.88; 95% confidence interval, 1.27-27.14; P = .04). Fluconazole remains the treatment of choice for maintenance therapy for AIDS-associated cryptococcal disease. Flucytosine may contribute to the prevention of relapse if used during the first 2 weeks of primary therapy.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy*
  • AIDS-Related Opportunistic Infections / immunology
  • Adult
  • Antifungal Agents / therapeutic use*
  • Cryptococcosis / drug therapy*
  • Cryptococcosis / immunology
  • Double-Blind Method
  • Female
  • Fluconazole / adverse effects
  • Fluconazole / therapeutic use*
  • Humans
  • Itraconazole / adverse effects
  • Itraconazole / therapeutic use*
  • Male
  • Meningitis, Fungal / drug therapy*
  • Meningitis, Fungal / immunology
  • Treatment Outcome

Substances

  • Antifungal Agents
  • Itraconazole
  • Fluconazole