Document 0787
 DOCN  M9550787
 TI    Initial therapy for acquired immunodeficiency syndrome-associated
       cryptococcosis with fluconazole.
 DT    9505
 AU    Nightingale SD; Department of Internal Medicine, University of Texas
       Southwestern; Medical Center at Dallas.
 SO    Arch Intern Med. 1995 Mar 13;155(5):538-40. Unique Identifier : AIDSLINE
       MED/95168948
 AB    BACKGROUND: Published opinion has generally favored amphotericin B over
       fluconazole as initial therapy for acquired immunodeficiency
       syndrome-associated cryptococcosis, although data that support this
       recommendation are limited. METHOD: Retrospective review of 30
       consecutive patients with acquired immunodeficiency syndrome-associated
       cryptococcosis seen at a single institution over a 1-year period and
       given fluconazole, 400 mg/d, as initial therapy. RESULTS: No patient
       died within the first 30 days of therapy, and none of the 14 patients
       who died within 1 year had clinically detectable infection when last
       seen or at death. Pretreatment blood cultures were positive in 26 of 27
       patients; cerebrospinal fluid cryptococcal antigen titer was greater
       than 1:1024 in 12 of 23 patients; and five of 30 patients presented with
       altered mental status. The median CD4 count at diagnosis was 0.042 x
       10(9)/L (42/microL). Eight of 25 patients who were followed up for more
       than 30 days relapsed, as evidenced by a positive culture; all relapses
       were successfully treated with fluconazole, either by reinstitution of
       therapy or by increase of dosage. CONCLUSION: This experience supports
       the use of fluconazole as initial therapy for acquired immunodeficiency
       syndrome-associated cryptococcosis.
 DE    Adult  AIDS-Related Opportunistic Infections/*DRUG THERAPY
       Cryptococcosis/*DRUG THERAPY  Female  Fluconazole/*THERAPEUTIC USE
       Human  Male  Recurrence  Retrospective Studies  Treatment Outcome
       CLINICAL TRIAL  JOURNAL ARTICLE

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