Summary of findings 8. Two weeks of AmBd + FLU compared to two weeks of AmBd for HIV‐associated cryptococcal meningitis.
| Two weeks of AmBd + FLU compared to two weeks of AmBd for HIV‐associated cryptococcal meningitis | |||||
| Patient or population: HIV‐infected individual with first episode of cryptococcal meningitis Setting: randomized controlled trial Intervention: 2 weeks of AmBd + FLU Comparison: 2 weeks of AmBd | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | Number of participants (trials) | Certainty of the evidence (GRADE) | |
| Risk with 2 weeks of AmBd | Risk with 2 weeks of AmBd + FLU | ||||
| Mortality: 10 weeks | 338 per 1000 | 317 per 1000 (186 to 547) | RR 0.94 (0.55 to 1.62) | 371 (3 RCTs) | ⊕⊕⊝⊝ LOW1,2 |
| *The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). Abbreviations: AmBd: amphotericin B deoxycholate; CI: confidence interval; FLU: fluconazole; RCT: randomized controlled trial; RR: risk ratio | |||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | |||||
1Downgraded one level for indirectness. Some participants received a lower dose of fluconazole than currently recommended in combination with AmBd. Pappas 2009 excluded from enrolment patients who were not expected to survive two weeks, so the study population may not be representative of general patients with cryptococcal meningitis. 2Downgraded one level for imprecision. Few events with broad CI including appreciable benefit and appreciable harm.