AmphotericinB and Fluorocytosine Combined with Voriconazole for the Treatment of Non-HIV- and Non-Transplant-Associated Cryptococcal Meningitis: A Retrospective Study

Abstract

\n Background\n\nThis retrospective study aimed to explore the curative effect of amphotericin B (AMB) and fluorocytosine (5-FC) combined with voriconazole (VOR) in the induction period for the treatment of non-HIV- and non-transplant-associated cryptococcal meningitis (CM).\nMethods\n\nClinical data from patients admitted to the Third Affiliated Hospital of Sun Yat Sen University from January 2011 to December 2020 were collected. The patients were stratified based on antifungal treatment methods in the induction period (group I with AMB\u2009+\u20095-FC\u2009+\u2009VOR, group II with AMB\u2009+\u20095-FC\u2009+\u2009FLU, group III with AMB\u2009+\u20095-FC).\nResults\n\nThe length of hospital stay in group I was significantly shorter than those in group II (p\u2009=\u20090.000) and group III (p\u2009=\u20090.000). Among the patients who achieved CSF sterility within 10 weeks, the number of days to reach CSF sterility in group I was shorter than that in group II (p\u2009=\u20090.046). The incidence of hypokalemia in group I was significantly lower than those in group II (p\u2009=\u20090.003) and group III (p\u2009=\u20090.004). The incidence of gastrointestinal discomfort in group I was significantly lower than that in group II (p\u2009=\u20090.004).\nConclusion\n\nAMB plus 5-FC combined with VOR for the induction treatment of non-HIV- and non-transplant-associated cryptococcal meningitis is a better choice than AMB plus 5-FC combined with FLU and AMB plus 5-FC. This new triple antifungal treatment method rapidly cleared the cryptococci from the CSF, substantially shortened the hospital stay, and decreased the incidences of hypokalemia and gastrointestinal discomfort.