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Aim <p>To evaluate the efficacy and safety of four antifungal regimens in treating non-HIV and non-transplant (NHNT) cryptococcal meningitis (CM) patients with high cryptococcal count (≥ 10,000/ml).</p> Methods <p>A retrospective analysis was conducted on 135 NHNT CM patients with high cryptococcal count who were admitted to the Third Affiliated Hospital of Sun Yat-sen University from 2008 to 2023. Patients were categorized into four groups based on the antifungal regimen used during the induction period (Group1: Amphotericin B-deoxycholate (AmB-d) + 5-flucytosine (5-FC) + Voriconazole (VOR); Group2: AmB-d + 5-FC + Fluconazole (FLU); Group3: AmB-d + 5-FC; Group4: 5-FC + FLU). Treatment outcomes were assessed by comparing responses at 10&#xa0;weeks.</p> Results <p>Baseline characteristics were comparable across the four groups. After 2&#xa0;weeks of follow-up, the positive rate of <i>Cryptococcus</i> culture in cerebrospinal fluid (CSF) of Group1 (1/30; 3.3%) was significantly lower (p &lt; 0.05) than that of Group2 and Group4 (Group2: 11/45; 24.4%; Group4: 22/43; 51.2%); the frequency of anemia in Group1(24/30; 80.0%) was significantly higher (p &lt; 0.05) than that of Group3 and Group4 (Group3: 6/15; 40.0%; Group4: 20/43; 46.5%); and the frequency of renal impairment in Group1 (20/30; 66.7%) was significantly higher (p &lt; 0.05) than that of Group2 and Group4 (Group2: 16/45; 35.6%; Group4: 4/43; 9.3%). Multivariate analysis showed significant associations between treatment groups and the 10-week unsuccessful outcome, with Group 1 having the lowest odds ratio (OR 0.04, 95% CI 0.01–0.22, p &lt; 0.001) when compared to the reference group (Group 3, AmB-d + 5-FC).</p> Conclusions <p>Our observations suggested potential benefits of the AmB-d + 5-FC + VOR regimen over AmB-d + 5-FC and 5-FC + FLU for NHNT CM patients. However, clinicians must closely monitor potential side effects, particularly anemia and renal impairment, associated with this regimen.</p>

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Comparison of the Efficacy and Safety of Different Antifungal Regimen Combinations in Non-HIV and Non-transplant Cryptococcal Meningitis Patients with High Cryptococcal Count

  • 期刊论文

  • 发表日期：

    2026年1月14日

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  • Junyu Liu,
  • Dongcheng Li,
  • Jia Liu,
  • Yaxin Lu,
  • Jiayin Liang,
  • Xiaohong Su,
  • Zheqi Li,
  • Zifeng Liu,
  • Ying Jiang,
  • Fuhua Peng

摘要

Aim

To evaluate the efficacy and safety of four antifungal regimens in treating non-HIV and non-transplant (NHNT) cryptococcal meningitis (CM) patients with high cryptococcal count (≥ 10,000/ml).

Methods

A retrospective analysis was conducted on 135 NHNT CM patients with high cryptococcal count who were admitted to the Third Affiliated Hospital of Sun Yat-sen University from 2008 to 2023. Patients were categorized into four groups based on the antifungal regimen used during the induction period (Group1: Amphotericin B-deoxycholate (AmB-d) + 5-flucytosine (5-FC) + Voriconazole (VOR); Group2: AmB-d + 5-FC + Fluconazole (FLU); Group3: AmB-d + 5-FC; Group4: 5-FC + FLU). Treatment outcomes were assessed by comparing responses at 10 weeks.

Results

Baseline characteristics were comparable across the four groups. After 2 weeks of follow-up, the positive rate of Cryptococcus culture in cerebrospinal fluid (CSF) of Group1 (1/30; 3.3%) was significantly lower (p < 0.05) than that of Group2 and Group4 (Group2: 11/45; 24.4%; Group4: 22/43; 51.2%); the frequency of anemia in Group1(24/30; 80.0%) was significantly higher (p < 0.05) than that of Group3 and Group4 (Group3: 6/15; 40.0%; Group4: 20/43; 46.5%); and the frequency of renal impairment in Group1 (20/30; 66.7%) was significantly higher (p < 0.05) than that of Group2 and Group4 (Group2: 16/45; 35.6%; Group4: 4/43; 9.3%). Multivariate analysis showed significant associations between treatment groups and the 10-week unsuccessful outcome, with Group 1 having the lowest odds ratio (OR 0.04, 95% CI 0.01–0.22, p < 0.001) when compared to the reference group (Group 3, AmB-d + 5-FC).

Conclusions

Our observations suggested potential benefits of the AmB-d + 5-FC + VOR regimen over AmB-d + 5-FC and 5-FC + FLU for NHNT CM patients. However, clinicians must closely monitor potential side effects, particularly anemia and renal impairment, associated with this regimen.