Table 3.
Antifungal Treatment Recommendations for Cryptococcal Meningoencephalitis in Transplant Recipients
| Regimen | Duration | Evidence |
|---|---|---|
| Induction therapy:a liposomal AmB (3–4 mg/kg per day) or ABLC (5 mg/kg per day) plus flucytosine (100 mg/kg per day) | 2 weeks | B-III |
| Alternatives for induction therapy | ||
| Liposomal AmB (6 mg/kg per day) or ABLC (5 mg/kg per day) | 4–6 weeks | B-III |
| AmBd (0.7 mg/kg per day)b | 4–6 weeks | B-III |
| Consolidation therapy: fluconazole (400–800 mg per day) | 8 weeks | B-III |
| Maintenance therapy: fluconazole (200–400 mg per day) | 6 months to 1 year | B-III |
NOTE. ABLC, amphotericin B lipid complex; AmB, amphotericin B; AmBd, amphotericin B deoxycholate.
a
Immunosuppressive management may require sequential or step-wise reductions.
b
Many transplant recipients have been successfully treated with AmBd; however, issues of renal dysfunction with calcineurin inhibitors are important and the effective dose is imprecise.