World Health Organization’s recommended induction, consolidation and maintenance phase treatment and dosage for HIV adults, adolescents and children (2011)
Induction Phase Treatment
For the induction phase of treatment in HIV-infected adults, adolescents and children with cryptococcal disease (meningeal and disseminated non-meningeal), the following two-week anti-fungal regimens are recommended in order of preference.
- Amphotericin B + Flucytosine
- Amphotericin B + Fluconazole
- Amphotericin B short course (5-7 days) + high-dose fluconazole (to complete two weeks of induction) when a minimum package of pre-emptive hydration and electrolyte replacement and toxicity monitoring and management cannot be provided for the full two week induction period.
- Fluconazole high dose + Flucytosine, when amphotericin B is not available
- Fluconazole high dose alone, when Amphotericin B is not available
Consolidation phase treatment
For the consolidation phase treatment of HIV-infected adults, adolescents and children with cryptococcal meningitis or disseminated non-meningeal disease, the following eight-week anti-fungal regimen is recommended:
- Fluconazole 400-800 mg/day after a two-week induction with amphotericin B regimen (6-12 mg/kg/day up to 400-800 mg/day if below 19 years).
- Fluconazole800mg/dayafterinductiontreatmentwithshortcourseamphotericin B or a fluconazole based induction regimen (fluconazole 12 mg/kg/day up to 800 mg/day if below 19 years).
Maintenance treatment (or secondary prophylaxis)
For maintenance treatment of cryptococcal disease in HIV-infected adults, adolescents and children, oral fluconazole 200 mg daily (6 mg/kg/day up to 200 mg/day if below 19 years) is recommended.
Localized non-meningeal disease
For localized non-meningeal disease, or in patients with isolated serum CrAg positivity (where active cryptococcal meningitis has been excluded), fluconazole 800 mg/day (or 12 mg/kg/day up to 800 mg/day if below 19 years) for two weeks, then 400 mg/day (or 6 mg/kg/day up to 400-800 mg/day if below 19 years) for eight weeks, and continued maintenance with fluconazole 200 mg/day is recommended. The optimal antifungal regimen in this population remains to be determined.