Comparison of old and new treatment regimen for Cryptococcal Meningitis within the induction phase at Klerksdorp/Tshepong Hospital Complex, a retrospective audit

Abstract

Background Cryptococcal meningitis causes substantial morbidity and mortality in people living with HIV(LWH), especially in sub-Saharan Africa. Appropriate therapy with effective and safe regimens mitigates consequences of cryptococcal meningitis. Objectives This study compares mortality rates during and after the induction phase between the prior and current regimens for treating cryptococcal meningitis. Methods. In this retrospective review, we included adults LWH diagnosed with cryptococcal meningitis, who received either amphotericin B 1mg/kg/day with fluconazole (1200mg) for 14 days -old regimen - or amphotericin B (1mg/kg/day) with flucytosine(100mg/kg/day) in the first week followed by fluconazole (1200mg) in the second week-new regimen. We evaluated differences in mortality during and after the induction phase and compared characteristics and side effects between the groups using descriptive statistics. Results From a potential total group of 300 patients, we included the data of 91 patients between Jan 2015 to Dec 2022; 29 (31.87%) received the old regimen while 62 (68.13%) received the new regimen. All patients had laboratory-confirmed cerebrospinal fluid evidence of cryptococcal meningitis. After the start of induction , there were seven deaths among the patients treated with the old regimen ,compared to four deaths in the group treated with the new regimen. Conclusion. Both regimens demonstrated safety : however ,our findings indicate that the old regimen was less effective than the new regimen.. Moreover the new regimen’s potential for reduced hospital stay suggests preference for its use compared to the old 4 regimen