Cryptococcus spp.

Management

Induction (first 2+ weeks): Liposomal amphotericin B (3-4 mg/kg IV daily) plus flucytosine (100 mg/kg per day orally in 4 divided doses)
- IV formulations may be used in severe cases and in those without oral intake where the preparation is available) for at least 2 weeks
Consolidation: fluconazole (400 mg [6 mg/kg] per day orally) for a minimum of 8 weeks
Maintenance:
- Fluconazole (200 mg per day orally) or Itraconazole (200 mg twice per day orally; drug-level monitoring strongly advised)
- Start HAART 2–10 weeks after starting antifungals
- Consider stopping antifungals once CD4 >= 100 for 3 months

First, rule out meningitis with an LP
If no meningitis, can treat with fluconazole 400 mg po daily until immune reconstitution

Induction (first 2+ weeks): Liposomal AmB (3–4 mg/kg per day IV) plus flucytosine (100 mg/kg per day in 4 divided doses)
- If not including flucytosine, then extend induction to 4-6 weeks
Consolidation: fluconazole (400–800 mg [6–12 mg/kg] per day orally) for 8 weeks, then by fluconazole (200–400 mg per day orally) for 6–12 months (B-II)

Induction (first 4+ weeks): AmBd (0.7–1.0 mg/kg per day IV) plus flucytosine (100 mg/kg per day orally in 4 divided doses)
- If neurological complications or positive CSF cultures after 2 weeks of treatment, consider extending to 6 weeks total
- If not including flucytosine, then extend induction by 2 weeks
- For AmBd toxicity issues, LFAmB may be substituted in the second 2 weeks
Consolidation: fluconazole (400 mg per day) for 8 weeks
Maintenance: fluconazole (200 mg [3 mg/kg] per day orally) for 6–12 months