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A Comparison of Amphotericin B Alone and Combined with Flucytosine in the Treatment of Cryptoccal Meningitis
Abstract
We compared amphotericin B therapy for cryptococcal meningitis with a newer regimen containing both amphotericin B and flucytosine. In 50 patients with 51 courses of therapy adherent to the protocol, 27 courses were with amphotericin B and 24 with the combination. Even though the combination regimen was given for only six weeks and amphotericin B for 10 weeks, the combination cured or improved more patients (16 vs 11), produced fewer failures or relapses (three vs. 11), more rapid sterilization of the cerebrospinal fluid (P less than 0.001) and less nephrotoxicity (P less than 0.05) than did amphotericin B alone. The number of deaths was the same (five) with each regimen. Adverse reactions to flucytosine occurred in 11 of 34 patients but were not life threatening. We conclude that combined flucytosine-amphoericin B therapy is the regimen of choice in cryptococcal meningitis.
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Cited by
Perfect, J. R., Dismukes, W. E., Dromer, F., Goldman, D. L., Graybill, J. R., Hamill, R. J., Harrison, T. S., Larsen, R. A., Lortholary, O., Nguyen, M.-H., et al. (2010) · Clinical Infectious Diseases · doi:10.1086/649858 · Cited by 2,660
Self-citationCryptococcosis in the era of AIDS--100 years after the discovery of Cryptococcus neoformans
Mitchell, T. G., & Perfect, J. R. (1995) · Clinical Microbiology Reviews · doi:10.1128/cmr.8.4.515 · Cited by 1,213
Treatment of Cryptococcal Meningitis Associated with the Acquired Immunodeficiency Syndrome
van der Horst, C. M., Saag, M. S., Cloud, G. A., Hamill, R. J., Graybill, J. R., Sobel, J. D., Johnson, P. C., Tuazon, C. U., Kerkering, T., Moskovitz, B. L., et al. (1997) · New England Journal of Medicine · doi:10.1056/nejm199707033370103 · Cited by 820
Self-citationVermes, A. (2000) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/46.2.171 · Cited by 803
Maziarz, E. K., & Perfect, J. R. (2016) · Infectious Disease Clinics of North America · doi:10.1016/j.idc.2015.10.006 · Cited by 698
Metadata
- Authors
- Bennett, J. E., Dismukes, W. E., Duma, R. J., Medoff, G., Sande, M. A., Gallis, H., Leonard, J., Fields, B. T., Bradshaw, M., Haywood, H., McGee, Z. A., Cate, T. R., Cobbs, C. G., Warner, J. F., & Alling, D. W.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1979-07-19
- Volume
- 301
- Issue
- 3
- Pages
- 126-131
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W1997032499
- Cited by
- 863
- References
- 0
- FWCI
- 29.79
- Type
- journal article
- Language
- en
- Open access
- closed
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- CoChat. (2026). Citation check: A Comparison of Amphotericin B Alone and Combined with Flucytosine in the Treatment of Cryptoccal Meningitis. https://app.cochat.ai/papers/10.1056/nejm197907193010303
- The paper
- Bennett, J. E., Dismukes, W. E., Duma, R. J., Medoff, G., Sande, M. A., Gallis, H., Leonard, J., Fields, B. T., Bradshaw, M., Haywood, H., McGee, Z. A., Cate, T. R., Cobbs, C. G., Warner, J. F., & Alling, D. W. (1979). A Comparison of Amphotericin B Alone and Combined with Flucytosine in the Treatment of Cryptoccal Meningitis. New England Journal of Medicine. https://doi.org/10.1056/nejm197907193010303
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