Cryptococcosis induction therapy
For cryptococcosis induction therapy in adults and children requiring 3-phase antifungal therapy, as a 2-drug regimen, useChang 2021:
amphotericin B liposomal (adult and child) 3 to 4 mg/kg intravenously, daily12. See advice on duration of therapyamphotericin b liposomalamphotericin B liposomalamphotericin B liposomal
PLUS
flucytosine (adult and child) 25 mg/kg orally, 6-hourly. For dosage adjustment in adults with kidney impairment, see flucytosine dosage adjustment. Monitor plasma concentration and full blood count (see Monitoring flucytosine)34. See advice on duration of therapy. flucytosine flucytosine flucytosine
For patients weighing more than 120 kg, amphotericin and flucytosine dosing is uncertain – seek expert advice.
Alternative drugs and regimens have been used for induction therapy of cryptococcosis but due to increased risk of toxicity, inferiority, or lack of experience outside of resource limited settings, are usually not preferred. Such regimens includeChang 2024:
- alternative amphotericin formulations (ie amphotericin B deoxycholate [0.8 to 1.0 mg/kg/day] or amphotericin B lipid complex)56
- amphotericin-based therapy without flucytosine
- high-dose fluconazole (800 to 1200 mg daily) with or without flucytosine
- a single high-dose of amphotericin B liposomal (10 mg/kg) with 14 days of oral flucytosine and high dose fluconazole7Jarvis 2022.