FLUCONAZOLE TREATMENT OF PERSISTENT CRYPTOCOCCUS-NEOFORMANS PROSTATIC INFECTION IN AIDS

Additional amphotericin B therapy has been ineffective for Cryptococcus neoformans infection of the prostate persisting after completion of standard therapy for cryptococcal meningitis in patients with the acquired immunodeficiency syndrome (AIDS). In a prospective open-label trial of fluconazole therapy, of 14 patients (50%, 95% CI, 26% to 74%) had sustained suppression of cryptococcuria at a median of 4 weeks of treatment, whereas seven others continued to shed C. neoformans after a median of 29 weeks. Response to initial therapy occurred in none of four patients initially treated with fluconazole, 100 mg daily and 5 of 10 initially treated with higher doses. Two of 14 patients (14%; CI, 5% to 23%) had recurrent meningitis; both had ongoing cryptococcuria but negative serum and cerebrospinal fluid cryptococcal antigen titers until presenting with relapse. Until new agents or higher doses of fluconazole are evaluated, fluconazole at doses of 200 to 600 mg daily should be used for the treatment of persistent C. neoformans infection of the prostate.