A prospective longitudinal study of the clinical outcomes from cryptococcal meningitis following treatment induction with 800 mg oral fluconazole in Blantyre, Malawi
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Introduction:Cryptococcal meningitis is the most common neurological infection in HIV infected patients in Sub Saharan Africa, where gold standard treatment with intravenous amphotericin B and 5 flucytosine is often unavailable or difficult to administer. Fluconazole monotherapy is frequently recommended in national guidelines but is a fungistatic drug compromised by uncertainty over optimal dosing and a paucity of clinical end-point outcome data.Methods:From July 2010 until March 2011, HIV infected adults with a first episode of cryptococcal meningitis were recruited at Queen Elizabeth Central Hospital, Blantyre, Malawi. Patients were treated with oral fluconazole monotherapy 800 mg daily, as per national guidelines. ART was started at 4 weeks. Outcomes and factors associated with treatment failure were assessed 4, 10 and 52 weeks after fluconazole initiation.Results:Sixty patients were recruited. 26/60 (43%) died by 4 weeks. 35/60 (58.0%) and 43/56 (77%) died or failed treatment by 10 or 52 weeks respectively. Reduced consciousness (Glasgow Coma Score 3 of 5) and confusion (Abbreviated Mental Test Score
Rothe , C , Sloan , D J , Goodson , P , Chikafa , J , Mukaka , M , Denis , B , Harrison , T , van Oosterhout , J J , Heyderman , R S , Lalloo , D G , Allain , T & Feasey , N A 2013 , ' A prospective longitudinal study of the clinical outcomes from cryptococcal meningitis following treatment induction with 800 mg oral fluconazole in Blantyre, Malawi ' , PLoS One , vol. 8 , no. 6 , e67311 . https://doi.org/10.1371/journal.pone.0067311
© 2013 Rothe et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
DescriptionDr. Feasey was supported by a Wellcome Research Training Fellowship and MLW is funded by a Wellcome Trust Major Overseas Project Grant (award number 084679/Z/08/Z).
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