Symptomatic, non-meningeal cryptococcosis

B20.5

• Description
• Medicine treatment

DESCRIPTION

Cryptococcal infection confirmed on culture or serum CrAg positive with non-meningeal disease. Any anatomical site may be involved, but the lungs are the commonest site.

MEDICINE TREATMENT

Induction phase

• Fluconazole, oral 1200 mg daily for 14 days.

AND

• Amphotericin B, slow IV infusion, 1 mg/kg daily in dextrose 5 % over 4 hours for 14 days.
  • Ensure adequate hydration to minimise nephrotoxicity. (See AMPHOTERICIN B, IV for preventing, monitoring and management of toxicity).

Consolidation phase

Follow with:

• Fluconazole, oral, 800 mg daily for 8 weeks.

Maintenance phase

• Fluconazole, oral, 200 mg daily.
  • Continue for at least 1 year provided that the CD4 count increases to >200 cells/mm3 on ART. If the CD4 count does not increase continue treatment indefinitely.

LoEIII [35]

• Commence ART 4–6 weeks after starting antifungal therapy. See section 10.1: Antiretroviral therapy.