The DOI matches its Crossref record; 18 of the 18 references it cites were found in a registry or an index.
Treatment of Cryptococcal Meningitis with Combination Amphotericin B and Flucytosine for Four as Compared with Six Weeks
Abstract
One hundred ninety-four patients with cryptococcal meningitis were enrolled in a multicenter, prospective, randomized clinical trial to compare the efficacy and toxicity of four as compared with six weeks of combination amphotericin B and flucytosine therapy. Among 91 patients who met preestablished criteria for randomization, cure or improvement was noted in 75 percent of those treated for four weeks and in 85 percent of those treated for six weeks. The estimated relapse rate for the four-week regimen was higher--27 as compared with 16 percent--whereas the incidence of toxic effects for the two regimens was similar--44 as compared with 43 percent. Among 23 transplant recipients, 4 of 5 treated for four weeks relapsed, leading to the decision to treat the rest of the group for six weeks. Only 3 of the 18 treated for six weeks relapsed. In a third group of 80 patients, the protocol was not followed during the initial four weeks, and these patients were not randomized. Thirty-eight died or relapsed. Multifactorial analysis of pretreatment factors for all 194 patients identified three significant predictors (P less than 0.05) of a favorable response: headache as a symptom, normal mental status, and a cerebrospinal fluid white-cell count above 20 per cubic millimeter. These and other findings in this study are consistent with the view that the four-week regimen should be reserved for patients who have meningitis without neurologic complications, underlying disease, or immunosuppressive therapy; a pretreatment cerebrospinal fluid white-cell count above 20 per cubic millimeter and a serum cryptococcal antigen titer below 1:32; and at four weeks of therapy, a negative cerebrospinal fluid India ink preparation and serum and cerebrospinal fluid cryptococcal-antigen titers below 1:8. Patients who do not meet these criteria should receive at least six weeks of therapy.
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Cites
Nonparametric Estimation from Incomplete Observations
Kaplan, E. L., & Meier, P. (1992) · Springer Series in Statistics · doi:10.1007/978-1-4612-4380-9_25 · Cited by 45,181
Regression Models and Life-Tables
Cox, D. R. (1972) · Journal of the Royal Statistical Society Series B: Statistical Methodology · doi:10.1111/j.2517-6161.1972.tb00899.x · Cited by 39,793
Nonparametric Estimation from Incomplete Observations
Kaplan, E. L., & Meier, P. (1958) · Journal of the American Statistical Association · doi:10.1080/01621459.1958.10501452 · Cited by 39,158
“Proving the null hypothesis” in clinical trials
Blackwelder, W. C. (1982) · Controlled Clinical Trials · doi:10.1016/0197-2456(82)90024-1 · Cited by 887
Self-citationBennett, J. E., Dismukes, W. E., Duma, R. J., Medoff, G., Sande, M. A., Gallis, H., Leonard, J., Fields, B. T., Bradshaw, M., Haywood, H., et al. (1979) · New England Journal of Medicine · doi:10.1056/nejm197907193010303 · Cited by 863
Self-citationCryptococcosis in the Acquired Immunodeficiency Syndrome
KOVACS, J. A., KOVACS, A. A., POLIS, M., WRIGHT, W. C., GILL, V. J., TUAZON, C. U., GELMANN, E. P., LANE, H. C., LONGFIELD, R., OVERTURF, G., et al. (1985) · Annals of Internal Medicine · doi:10.7326/0003-4819-103-4-533 · Cited by 621
Prognostic Factors in Cryptococcal Meningitis: A Study in 111 Cases
DIAMOND, R. D., & BENNETT, J. E. (1974) · Annals of Internal Medicine · doi:10.7326/0003-4819-80-2-176 · Cited by 605
ZUGER, A., LOUIE, E., HOLZMAN, R. S., SIMBERKOFF, M. S., & RAHAL, J. J. (1986) · Annals of Internal Medicine · doi:10.7326/0003-4819-104-2-234 · Cited by 522
Butler, W. T., Alling, D. W., Spickard, A., & Utz, J. P. (1964) · New England Journal of Medicine · doi:10.1056/nejm196401092700201 · Cited by 196
Diagnosis of Cryptococcal Meningitis: Value of Immunologic Detection of Cryptococcal Antigen
Goodman, J. S., Kaufman, L., & Koenig, M. G. (1971) · New England Journal of Medicine · doi:10.1056/nejm197108192850804 · Cited by 160
Self-citation
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
- Dismukes, W. E., Cloud, G., Gallis, H. A., Kerkering, T. M., Medoff, G., Craven, P. C., Kaplowitz, L. G., Fisher, J. F., Gregg, C. R., Bowles, C. A., Shadomy, S., Stamm, A. M., Diasio, R. B., Kaufman, L., Soong, S.-J., Blackwelder, W. C., & The National Institute of Allergy and Infectious Diseases Mycoses Study Group*
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1987-08-06
- Volume
- 317
- Issue
- 6
- Pages
- 334-341
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2319879113
- Cited by
- 417
- References
- 18
- FWCI
- 17.38
- Type
- journal article
- Language
- en
- Open access
- closed
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- CoChat. (2026). Citation check: Treatment of Cryptococcal Meningitis with Combination Amphotericin B and Flucytosine for Four as Compared with Six Weeks. https://app.cochat.ai/papers/10.1056/nejm198708063170602
- The paper
- Dismukes, W. E., Cloud, G., Gallis, H. A., Kerkering, T. M., Medoff, G., Craven, P. C., Kaplowitz, L. G., Fisher, J. F., Gregg, C. R., Bowles, C. A., Shadomy, S., Stamm, A. M., Diasio, R. B., Kaufman, L., Soong, S.-J., Blackwelder, W. C., & The National Institute of Allergy and Infectious Diseases Mycoses Study Group*. (1987). Treatment of Cryptococcal Meningitis with Combination Amphotericin B and Flucytosine for Four as Compared with Six Weeks. New England Journal of Medicine. https://doi.org/10.1056/nejm198708063170602
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Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.
