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A prospective study of mortality from cryptococcal meningitis following treatment induction with 1200mg oral fluconazole in Blantyre, Malawi
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dc.contributor.author | Gaskell, Katherine M. | |
dc.contributor.author | Rothe, Camilla | |
dc.contributor.author | Gnanadurai, Roshina | |
dc.contributor.author | Goodson, Patrick | |
dc.contributor.author | Jassi, Chikondi | |
dc.contributor.author | Heyderman, Robert S. | |
dc.contributor.author | Allain, Theresa J. | |
dc.contributor.author | Harrison, Thomas S. | |
dc.contributor.author | Lalloo, David G. | |
dc.contributor.author | Sloan, Derek J. | |
dc.contributor.author | Feasey, Nicholas A. | |
dc.date.accessioned | 2018-03-27T13:30:07Z | |
dc.date.available | 2018-03-27T13:30:07Z | |
dc.date.issued | 2014-11-06 | |
dc.identifier | 241921489 | |
dc.identifier | 727ab913-42f0-4cbe-861d-cb268ca75858 | |
dc.identifier | 84910656554 | |
dc.identifier.citation | Gaskell , K M , Rothe , C , Gnanadurai , R , Goodson , P , Jassi , C , Heyderman , R S , Allain , T J , Harrison , T S , Lalloo , D G , Sloan , D J & Feasey , N A 2014 , ' A prospective study of mortality from cryptococcal meningitis following treatment induction with 1200mg oral fluconazole in Blantyre, Malawi ' , PLoS One , vol. 9 , no. 11 , e110285 . https://doi.org/10.1371/journal.pone.0110285 | en |
dc.identifier.issn | 1932-6203 | |
dc.identifier.other | ORCID: /0000-0002-7888-5449/work/60631023 | |
dc.identifier.uri | https://hdl.handle.net/10023/13030 | |
dc.description | There was no specific funding for this research. However MLW is supported by Wellcome Trust Core Award 084679/Z/08/Z. | en |
dc.description.abstract | Objective: We have previously reported high ten-week mortality from cryptococcal meningitis in Malawian adults following treatment-induction with 800mg oral fluconazole (57% [33/58]). National guidelines in Malawi and other African countries now advocate an increased induction dose of 1200mg. We assessed whether this has improved outcomes. Design: This was a prospective observational study of HIV-infected adults with cryptococcal meningitis confirmed by diagnostic lumbar puncture. Treatment was with fluconazole 1200mg/day for two weeks then 400mg/day for 8 weeks. Mortality within the first 10 weeks was the study end-point, and current results were compared with data from our prior patient cohort who started on fluconazole 800mg/day. Results: 47 participants received fluconazole monotherapy. Despite a treatment-induction dose of 1200mg, ten-week mortality remained 55% (26/47). This was no better than our previous study (Hazard Ratio [HR] of death on 1200mg vs. 800mg fluconazole: 1.29 (95% CI: 0.77-2.16, p=0.332)). There was some evidence for improved survival in patients who had repeat lumbar punctures during early therapy to lower intracranial pressure (HR: 0.27 [95% CI: 0.07-1.03, p = 0.055]). Conclusion: There remains an urgent need to identify more effective, affordable and deliverable regimens for cryptococcal meningitis. | |
dc.format.extent | 4 | |
dc.format.extent | 292150 | |
dc.language.iso | eng | |
dc.relation.ispartof | PLoS One | en |
dc.subject | RA0421 Public health. Hygiene. Preventive Medicine | en |
dc.subject | Agricultural and Biological Sciences(all) | en |
dc.subject | Biochemistry, Genetics and Molecular Biology(all) | en |
dc.subject | Medicine(all) | en |
dc.subject | SDG 3 - Good Health and Well-being | en |
dc.subject.lcc | RA0421 | en |
dc.title | A prospective study of mortality from cryptococcal meningitis following treatment induction with 1200mg oral fluconazole in Blantyre, Malawi | en |
dc.type | Journal article | en |
dc.contributor.institution | University of St Andrews. School of Medicine | en |
dc.contributor.institution | University of St Andrews. Infection and Global Health Division | en |
dc.identifier.doi | https://doi.org/10.1371/journal.pone.0110285 | |
dc.description.status | Peer reviewed | en |
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