ArticleMycopathologia2026
Comparison of the Efficacy and Safety of Different Antifungal Regimen Combinations in Non-HIV and Non-transplant Cryptococcal Meningitis Patients with High Cryptococcal Count.
Article in Mycopathologia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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10 authors.
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Abstract
aimTo evaluate the efficacy and safety of four antifungal regimens in treating non-HIV and non-transplant (NHNT) cryptococcal meningitis (CM) patients with high cryptococcal count (≥ 10,000/ml).
methodsA retrospective analysis was conducted on 135 NHNT CM patients with high cryptococcal count who were admitted to the Third Affiliated Hospital of Sun Yat-sen University from 2008 to 2023. Patients were categorized into four groups based on the antifungal regimen used during the induction period (Group1: Amphotericin B-deoxycholate (AmB-d) + 5-flucytosine (5-FC) + Voriconazole (VOR); Group2: AmB-d + 5-FC + Fluconazole (FLU); Group3: AmB-d + 5-FC; Group4: 5-FC + FLU). Treatment outcomes were assessed by comparing responses at 10 weeks.
resultsBaseline characteristics were comparable across the four groups. After 2 weeks of follow-up, the positive rate of Cryptococcus culture in cerebrospinal fluid (CSF) of Group1 (1/30; 3.3%) was significantly lower (p < 0.05) than that of Group2 and Group4 (Group2: 11/45; 24.4%; Group4: 22/43; 51.2%); the frequency of anemia in Group1(24/30; 80.0%) was significantly higher (p < 0.05) than that of Group3 and Group4 (Group3: 6/15; 40.0%; Group4: 20/43; 46.5%); and the frequency of renal impairment in Group1 (20/30; 66.7%) was significantly higher (p < 0.05) than that of Group2 and Group4 (Group2: 16/45; 35.6%; Group4: 4/43; 9.3%). Multivariate analysis showed significant associations between treatment groups and the 10-week unsuccessful outcome, with Group 1 having the lowest odds ratio (OR 0.04, 95% CI 0.01-0.22, p < 0.001) when compared to the reference group (Group 3, AmB-d + 5-FC).
conclusionsOur observations suggested potential benefits of the AmB-d + 5-FC + VOR regimen over AmB-d + 5-FC and 5-FC + FLU for NHNT CM patients. However, clinicians must closely monitor potential side effects, particularly anemia and renal impairment, associated with this regimen.
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