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. 2018 Jul 25;2018(7):CD005647. doi: 10.1002/14651858.CD005647.pub3

Jackson 2012.

Methods Study type: unblinded RCT
Setting: 1 referral hospital in Malawi
Participants Inclusion criteria: HIV infected; ART‐naive; diagnosed by CSF India ink confirmed by CrAg test or culture or by CSF CrAg test
Exclusion criteria: pregnant or breastfeeding; previous cryptococcal meningitis; ALT > 1200 IU/L; ANC < 500 x 106/L; platelets < 50 x 106/L; contraindication to any study medication
Number randomized: 43 (3 excluded after randomization for false‐positive India ink)
Age: median 35 years
Gender: 65% male
CD4 T‐cell count: median 41 cells/μL
Baseline ART: none (excluded if prior ART)
Baseline GCS/AMS: GCS < 15 in 25% of participants
Interventions Intervention
1: AmBd 1.0 mg/kg/day for 1 week and fluconazole 1200 mg/day for 2 weeks
2: AmBd 1.0 mg/kg/day for 1 week and fluconazole 1200 mg/day and flucytosine 100 mg/kg/day for 2 weeks
Consolidation: fluconazole 800 mg/day for 2 weeks, then 400 mg/day for 8 weeks, then 200 mg/day maintenance dose
Postdiagnosis ART: ART initiated at 4 weeks.
Lumbar puncture schedule: scheduled on days 1, 3, 7, and 14 and as clinically indicated
Laboratory monitoring: CBC, ALT, AST, K, Cr 3 times per week for first 2 weeks
Outcomes Primary outcome
  • Rate of CSF fungal clearance in first 2 weeks


Secondary outcomes
  • Mortality at 2 and 10 weeks

  • Drug safety

  • Serious adverse events


Outcome assessment schedule: daily while hospitalized, then scheduled for visit at 4 weeks to initiate ART, then followed until 10 weeks
Notes Date of study: 2009 to 2010
Funding: Medical Research Council (UK); Department for International Development in Malawi (UK)
Declaration of conflict of interest by authors: none reported.
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk 1:1 randomization stratified by GCS < 15 using random computer‐generated list
Allocation concealment (selection bias) Unclear risk Not specified
Blinding of participants and personnel (performance bias) 
 All outcomes High risk Treatment was not blinded.
Blinding of outcome assessment (detection bias) 
 All outcomes High risk Outcomes unblinded by assessors
Incomplete outcome data (attrition bias) 
 All outcomes Low risk Vital status known for most participants (39/40) at 10 weeks
Selective reporting (reporting bias) Low risk Authors reported on all primary and secondary outcomes.
Other bias Low risk None noted.