A patient with HIV and CD4 40 cells/µL develops headache and papilledema. CSF India ink preparation shows encapsulated yeasts. Initial antifungal therapy for cryptococcal meningitis should include:
- A Fluconazole 400 mg/day for 8 weeks
- B Voriconazole 200 mg twice daily
- C Liposomal amphotericin B + flucytosine for 2 weeks (induction phase) ✓
- D Itraconazole 200 mg twice daily
Explanation
WHO and IDSA guidelines for HIV-associated cryptococcal meningitis recommend a 3-phase approach: induction (liposomal/conventional amphotericin B + flucytosine for 2 weeks), consolidation (fluconazole 400 mg/day for 8 weeks), and maintenance (fluconazole 200 mg/day for ≥1 year until CD4 > 200 cells/µL on ART). The ACTA trial confirmed amphotericin B + flucytosine superiority over fluconazole-based induction in reducing 10-week mortality. Serial lumbar punctures for ICP management are also critical as elevated CSF pressure is the primary cause of early death. Fluconazole monotherapy induction is inferior.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.