Combination therapy with fluconazole and flucytosine for cryptococcal meningitis in Ugandan patients with AIDS

Clin Infect Dis. 1998 Jun;26(6):1362-6. doi: 10.1086/516372.


We performed a randomized trial in which combination therapy with fluconazole and short-term flucytosine was compared with fluconazole monotherapy in 58 patients with AIDS-associated cryptococcal meningitis (CM). Thirty of these patients were randomized to receive combination therapy with fluconazole, 200 mg once a day for 2 months, and flucytosine, 150 mg/(kg.d) for the first 2 weeks, and 28 were randomized to receive monotherapy with fluconazole at the same dose for 2 months. Patients in both groups who survived for 2 months received fluconazole as maintenance therapy at a dose of 200 mg three times per week for 4 months. The combination therapy prevented death within 2 weeks and significantly increased the survival rate among these patients (32%) at 6 months over that among patients receiving monotherapy (12%) (P = .022). The combination therapy also resulted in a significant decrease in the severity of headache after 1 month of treatment, compared with monotherapy (P = .005). No serious adverse reactions were observed in patients receiving either regimen. These data indicate that treatment with fluconazole and short-term flucytosine is a cost-effective and safe regimen that improves the quality of life for patients with AIDS-associated CM in developing countries where human immunodeficiency virus is endemic.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy*
  • Adult
  • Antifungal Agents / administration & dosage
  • Antifungal Agents / therapeutic use*
  • Drug Therapy, Combination
  • Female
  • Fluconazole / administration & dosage
  • Fluconazole / therapeutic use*
  • Flucytosine / administration & dosage
  • Flucytosine / therapeutic use*
  • Humans
  • Male
  • Meningitis, Cryptococcal / drug therapy*
  • Middle Aged
  • Uganda


  • Antifungal Agents
  • Fluconazole
  • Flucytosine