How is relapsed CNS cryptococcosis treated in HIV infection?

Updated: Jan 08, 2020
  • Author: Felicia J Gliksman, DO, MPH; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Patients who experience relapse should be restarted on induction-phase therapy. The susceptibility of the relapse isolate should be determined. A minimum inhibitory concentration (MIC) with a dilution difference of 3 or higher from the original isolate suggests development of direct drug resistance. Otherwise, an isolate with an MIC of 16 µg/mL or more for fluconazole or 32 µg/mL or more for flucytosine may be considered resistant, and alternative agents should be considered. [12]

Consider salvage consolidation therapy with fluconazole (800–1200 mg/day orally), voriconazole (200–400 mg twice daily orally), or posaconazole (200 mg orally 4 times daily or 400 mg orally twice daily) for 10–12 weeks. If there are compliance issues and a susceptible isolate, prior suppressive doses of fluconazole may be reinstituted. [12]

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