Page 95 - HPP ANTIMICROBIAL GUIDELINE 2018

Suggested Treatment
Infection/ Condition Comments
Preferred Alternative

Cryptococcus meningitis
ƚ
ƚ
Induction therapy Amphotericin B deoxycholate 0.7- Amphotericin B deoxycholate 1mg/kg ƚ The lipid formulations (Amphotericin
(for at least 2 weeks) 1mg/kg IV q24h IV q24h (1 week) B lipid complex 5mg/kg or liposomal
PLUS PLUS 3-4mg/kg IV q24h) may be used
Flucytosine 100mg/kg/24h PO in Flucytosine 100mg/kg/24h PO in instead if available
4 divided doses 4 divided doses
(For 2 weeks) (For 1 week) If ICP >250mmH2O or signs &
symptoms of increase ICP, do daily
OR Followed by LP to reduce pressure until patient is
Fluconazole 1200mg OD for 1 week improved
Fluconazole 1200mg PO q24h
PLUS If clinical signs of increase ICP do
5-Flucytosine 100mg/kg/24h PO in 4 not improve after about 2 weeks of
divided doses daily LPs, consider placement of a
(For 2 weeks) lumbar drain or VP shunt

Discontinuation:
• Completed induction, consolidation
Consolidation therapy Fluconazole 800mg PO q24h for therapy, and at least 1 year on
10 weeks maintenance therapy, and
• Remains asymptomatic from
cryptococcal infection, and
• CD4 count ≥200 cells/μL for ≥6
Maintenance Therapy Fluconazole 200mg PO q24h months and suppressed HIV RNA
in response to effective ART

HPP AMG Human Immunodeficiency Virus 42