Comparison of Amphotericin B and its combination with Flucytosine in the Management of Cryptococcal Meningitis: a Review

Cryptococcosis is a global invasive mycosis that is associated with high morbidity and mortality. With its profound propensity to locate within the central nervous system, which is frequently accompanying with fungal meningitis. Immunocompromised patients with cryptococcal meningitis should receive Amphotericin B deoxycholate 0.7–1.0 mg/kg/day intravenously plus Flucytosine 100 mg/kg/day divided into four doses for at least 2 weeks, followed by Fluconazole, 400 mg orally daily, for a minimum of 8 weeks OR Amphotericin B monotherapy for 10 weeks duration. Hence, the objective of this review was to compile evidences on comparison of effectiveness of Amphotericin alone and combined with Flucytosine in the management of cryptococcal meningitis. A literature review of research articles was done, by accessing electronic journals from MEDLINE, EMBASE, COCHRANE LIBRARY and PUBMED published from years 1979 to 2018. Findings of randomized clinical trials, studies done in English, and published documents were included in the review. The available evidences from the included studies finding supported that combining Amphotericin B with Flucytosine had better clinal improvement than AmB monotherapy. In all studies included Flucytosine addition resulted better outcomes in cerebrospinal fluid yeast count, serologic evidence, clinical symptoms, survival rate, or occurrence of adverse drug events.