Which combination is used to treat cryptococcal meningitis?

The preferred treatment for cryptococcal meningitis, particularly in immunocompromised patients such as those with HIV/AIDS, involves the use of a combination of medications. IV amphotericin B is a potent antifungal agent that helps rapidly reduce the fungal burden. Flucytosine, an antimetabolite that enhances the activity of amphotericin B, is also used in this combination due to its ability to penetrate the central nervous system effectively. This synergistic effect helps to achieve better outcomes compared to using either medication alone.

Using amphotericin B in conjunction with flucytosine is particularly effective in penetrating the blood-brain barrier and reducing the incidence of complications associated with cryptococcal meningitis, such as increased intracranial pressure and neurological deficits. This combination is typically administered for a period of time until clinical improvement is observed, after which fluconazole may be used for long-term maintenance therapy.

Other options like fluconazole alone are generally used for maintenance therapy after initial treatment but are not sufficient as the primary treatment for cryptococcal meningitis. Similarly, combinations such as voriconazole and amphotericin B or caspofungin with voriconazole are not standard treatments for cryptococcal infections, as