ITRACONAZOLE COMPARED WITH AMPHOTERICIN-B PLUS FLUCYTOSINE IN AIDS PATIENTS WITH CRYPTOCOCCAL MENINGITIS

被引:88
作者
DEGANS, J
PORTEGIES, P
TIESSENS, G
SCHATTENKERK, JKME
VANBOXTEL, CJ
VANKETEL, RJ
STAM, J
机构
[1] VEREENIGING ZIEKENVERPLEGING PRINSENGRACHT,DEPT NEUROL,AMSTERDAM,NETHERLANDS
[2] UNIV AMSTERDAM,ACAD MED CTR,DEPT NEUROL,1105 AZ AMSTERDAM,NETHERLANDS
[3] UNIV AMSTERDAM,ACAD MED CTR,DEPT INTERNAL MED,1105 AZ AMSTERDAM,NETHERLANDS
[4] UNIV AMSTERDAM,ACAD MED CTR,DEPT CLIN PHARMACOL,1105 AZ AMSTERDAM,NETHERLANDS
[5] UNIV AMSTERDAM,ACAD MED CTR,DEPT MICROBIOL,1105 AZ AMSTERDAM,NETHERLANDS
关键词
CRYPTOCOCCAL MENINGITIS; ITRACONAZOLE; AIDS;
D O I
10.1097/00002030-199202000-00007
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Objective: We conducted a comparison of itraconazole versus amphotericin B plus flucytosine in the initial treatment of cryptococcal meningitis is patients with AIDS and established the efficacy of itraconazole as maintenance treatment. Design: The trial was a prospective randomized, and non-blinded study. Setting: The study was performed at an academic centre for AIDS, Amsterdam, The Netherlands. Patients, participants: Twenty-eight HIV-1-seropositive men with a presumptive diagnosis of cryptococcal meningitis, randomized between 5 February 1987 and 1 January 1990, were included for analysis. Interventions: Oral itraconazole (200 mg twice daily), versus amphotericin B (0.3 mg/kg daily) intravenously plus oral flucytosine (150 mg/kg daily) was administered for 6 weeks followed by maintenance therapy with oral itraconazole (200 mg daily) to all patients. Main outcome measures: Outcome measures were a complete or partial response recrudescence and relapse. Results: A complete response was observed in five out of the 12 patients who completed 6 weeks of initial treatment with itraconazole versus all 10 patients who completed treatment with amphotericin B plus flucytosine (P = 0.009). A partial response was observed in seven out of the 14 patients assigned to itraconazole. During maintenance therapy, recrudescence (n = 6) or relapse (n = 1) occurred in seven out of the 12 patients initially assigned to itraconazole, whereas two relapses occurred among nine patients initially treated with amphotericin B plus flucytosine (P = 0.22); recurrence of clinical symptoms was significantly related to a positive cerebrospinal fluid culture at 6 weeks (P = 0.003). Conclusion: Itraconazole is less effective compared with amphotericin B plus flucytosine in achieving a complete response in initial therapy in AIDS patients with cryptococcal meningitis.
引用
收藏
页码:185 / 190
页数:6
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