Clinical Effectiveness and Safety of Amphotericin B With Flucytosine-Fluconazole Therapy for Cryptococcal Meningitis
Clinical Effectiveness and Safety of Amphotericin B With Flucytosine-Fluconazole Therapy for Cryptococcal Meningitis
To study the clinical effectiveness and safety of amphotericin B with flucytosine-fluconazole
 therapy for cryptococcal meningitis in patients with HIV infection.
Cryptococcal meningitis is an AIDS-defining illness mostly caused by the fungus, Cryptococcus
 neoformans. In high-income countries, the use of amphotericin B in combination with a more
 expensive drug, flucytosine, is most effective for the management of cryptococcal meningitis;
 but access to flucytosine is severely limited in middle and low-income countries. In Myanmar,
 currently recommended regimen for cryptococcal meningitis are combination of amphotericin B
 with fluconazole. Although amphotericin plus flucytosine followed by fluconazole therapy is
 the currently preferred regimen in WHO treatment guidelines, it is not still commonly used in
 Myanmar clinical practice because of its limited availability. Therefore, the data regarding
 tolerability and clinical effectiveness of flucytosine are unavailable for Myanmar patients.

 Although trials were carried out for investigating the effectiveness of flucytosine in the
 HIV population of Africa, the variability in drug response can occur in Myanmar patients due
 to the racial and genetic differences and whether it is effective and safe for Myanmar people
 is a great curiosity question for clinicians and healthcare workers. In Myanmar, amphotericin
 plus flucytosine followed by fluconazole regimen will be supplied by National AIDS Program
 (NAP) and indicated in 2020. Thus, the documents for effectiveness and safety profile need to
 be established. This is the reason that the effectiveness and safety of amphotericin B with
 flucytosine and fluconazole combination therapy should be studied. From this study, it can
 provide information to physicians regarding the effectiveness as well as safety of those
 drugs in the management of cryptococcal meningitis in HIV patients.
Inclusion Criteria:

 1. Patients with HIV-associated cryptococcal meningitis, admitted to inpatient department
 of SHW, SHM and SHT during the study period

 2. Patients of both sexes

 3. Age above 14 years

 4. Patients or caregivers who will give informed consent to participate in this study

 Exclusion Criteria:

 1. Pregnancy