Prophylaxis for Cryptococcal Meningitis

Primary prophylaxis

Antifungal prophylaxis is not to be used routinely to prevent cryptococcosis because of rarity of the disease, lack of survival benefit, possibility of drug interaction and potential development of antifungal drug resistance.

Secondary prophylaxis

• After successful treatment of cryptococcal meningitis, secondary prophylaxis should be given life-long.
• Fluconazole (3-6 mg/kg/day, max: 200 mg) may be effective.
• For adolescents receiving ART, maintenance fluconazole may be stopped if immune reconstitution occurs and CD 4 count increases to between 100-200 cells.
• Safety of discontinuation of secondary prophylaxis in children has not been studied extensively.