Table 2.

Treatment and dosage guidance for management of Cryptococcus neoformans and Cryptococcus gattii pulmonary infections. Modified from the Infectious Diseases Society of America (IDSA), American Society of Transplantation (AST), Australasian Antifungal Guidelines Steering Committee and the American Thoracic Society guidelines [8,9,39,95].

Host Risk Group/Severity of Disease	First Line Antifungal Therapy	Alternative Antifungal Regimen	Duration of Therapy/Comments
Immunocompetent -Mild-to-moderate	Fluconazole 400–800 mg orally, daily	Itraconazole (loading doses of 200 mg orally three times daily for three days, then 200 mg orally twice daily) Voriconazole (loading doses of 6 mg/kg intravenously twice daily or 400 mg orally twice daily on the first day, then 200 mg orally twice daily) Posaconazole delayed-release tablets (loading doses of 300 mg orally twice daily on the first day, then 300 mg orally once daily)	6 to 12 months
-Severe	Induction: Liposomal amphotericin 3 mg/kg/day intravenously (or conventional amphotericin 0.7–1.0 mg/kg/day) plus flucytosine 100 mg/kg/day orally Consolidation: Fluconazole 400–800 mg orally, daily Maintenance: Fluconazole 200-400 mg orally, daily		Induction: 2–4 weeks Consolidation: 8 weeks Maintenance: 12 months
Immunocompromised—HIV and non-HIV -Mild-to-moderate	Fluconazole 400 mg orally, daily	Itraconazole (loading doses of 200 mg orally three times daily for three days, then 200 mg orally twice daily) Voriconazole (loading doses of 6 mg/kg intravenously twice daily or 400 mg orally twice daily on the first day, then 200 mg orally twice daily) Posaconazole delayed-release tablets (loading doses of 300 mg orally twice daily on the first day, then 300 mg orally once daily)	6 to 12 months In patients with HIV coinfection, suppressive therapy (fluconazole 200 mg orally, daily) should be given after the acute treatment course. This may be ceased after 12 months if CD4 count > 100 cells/μL, HIV viral load is undetectable and cryptococcal antigen titre is stable at <1:512.
-Severe	Treat as for immunocompetent, severe disease
Pregnant women -Mild-to-moderate	“Watch and wait”, close clinical monitoring	Seek expert opinion Consider amphotericin in 1st trimester; fluconazole 400 mg orally, daily in 2nd and 3rd trimester if required	Recommended to defer treatment until after delivery unless severe disease
-Severe	Treat as for immunocompetent, severe disease with expert input
Children -Mild-to-moderate	Fluconazole 6–12 mg/kg orally, daily	Treat as for children, severe disease	6 to 12 months
-Severe	Induction: Amphotericin B 1 mg/kg per day intravenously plus flucytosine 100 mg/kg per day orally (in 4 divided doses) Consolidation: fluconazole 10–12 mg/kg per day orally Maintenance: fluconazole 6–12 mg/kg per day orally	Liposomal Amphotericin B 5 mg/kg per day intravenously (or Amphotericin B lipid complex 5 mg/kg per day intravenously)	Induction: 2 weeks Consolidation: 8 weeks Maintenance: 6 to 12 months