The Improved Prognosis of Cryptococcal Meningitis with Amphotericin B Therapy

Abstract

Thirty patients with cryptococcal meningitis were treated with amphotericin B. Fifty-three % were apparently cured after the first course of therapy, 30% relapsed and were retreated successfully and 17% failed to respond to therapy. Rates of relapse were unrelated to the total dose of drug given. Sixty-two% of cases had coexisting diseases; Hodgkin''s disease and mild diabetes were the illnesses most frequently seen. Corticosteroid therapy preceded the development of cryptococcal meningitis in 10 patients. Amphotericin-B therapy was begun with a 1mg dose and gradually increased until a dosage of approximately 1-1.5 mg/kg was achieved. This dose was modified according to the patient''s subjective symptoms and renal tolerance. Intrathecal administration of ampho-tericin-B was reserved for use in those patients who had relapsed, who failed to respond to intravenous treatment or who did not tolerate the intravenous route.