HIV in Children

TREATMENT FOR CRYPTOCOCCAL MENINGITIS

Dr. Ira Shah
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Last Updated : 1st September 2012
Drugs Dosage Adverse Effects Remarks
Amphotericin B 0.7-1.5 mg/kg/day IV OD for acute therapy (2 weeks of induction phase) Nephrotoxicity, fever, nausea, vomiting, hepatotoxicity, anemia, neurotoxicity, hyperkalemia Nephrotoxicity is related to cumulative dose
Flucytosine 100 mg/kg/day PO in 4 divided doses (2 weeks of induction phase) Bone marrow suppression, Hepatotoxicity, GI upset, Renal and skin toxicity Should be avoided in children with severe renal involvement. TDM levels should be between 40-60 µg/ml.
Fluconazole 10-12 mg/kg/day PO/IV BD (max: 800 mg/day) [8-10 weeks of consolidation phase]. 3-6 mg/kg/day PO (max:200 mg) [Secondary prophylaxis]. Skin rash, pruritis, Stevens Johnson syndrome, Hepatitis, alopecia in scalp & public area Inhibits P-450 cytochrome and thus adjustment with antiretroviral therapy is required.
Itraconazole 2-5 mg/kg/day PO BD [Consolidation phase - 8 weeks] Skin rash, pruritis, Thrombocytopenia, Leukopenia, hepatitis, GI upset Inhibits P450 cytochrome enzyme and thus has drug interactions with antiretroviral agents.
Liposomal Amphotericin B 3-5 mg/kg/day IV OD [Induction phase - 2 weeks] Acute infusion related reactions such as chest pain, dyspnea, hypoxia, abdominal pain, flushing and urticaria. Can be used instead of Amphotericin B in patients with renal insufficiency or infusion related toxicity to Amphotericin B.

Induction phase :


  • Amphotericin B + Flucytosine for 2 weeks

  •             OR
  • Amphotericin B for 2 weeks

  •             OR
  • Liposomal Amphotericin B + Flucytosine for 2 weeks

  •             OR
  • Liposomal Amphotericin B fro 2 weeks

Alternative :


  • Fluconazole + Flucytosine [Not enough data in children]

Consolidation phase :


  • Fluconazole for 8 – 10 weeks

  •             OR
  • Itraconazole for 2 weeks


TREATMENT FOR CRYPTOCOCCAL MENINGITIS
Dr. Ira Shah
Incharge Pediatric HIV and TB Clinic, B.J.Wadia Hospital for Children, Mumbai, India Consultant in Pediatric Infectious Diseases, Nanavati Hospital, Mumbai, India.