After a 2-week period of successful induction therapy, consolidation therapy should be initiated with fluconazole administered for 8 weeks or until CSF cultures are sterile. Alternative treatment: Therapy with fluconazole alone at a dose of 400-800 mg/daily is effective for treating AIDS-associated cryptococcal meningitis. Increased intracranial pressure might cause clinical deterioration despite a microbiologic response, probably reflects cerebral oedema, and is more likely if the CSF opening pressure is >200mm H2O. The opening pressure should always be measured when a lumbar puncture is performed. The principal initial intervention for reducing symptomatic intracranial pressure is repeated daily lumbar punctures. CSF shunting should be considered for patients in whom daily lumbar punctures are no longer tolerated or signs and symptoms of cerebral oedema are not relieved. *Corticosteroids (Dexamethazone) – Unlike with other situations of intracranial pressure, these drugs have no beneficial effect. Seizure activity associated with Cryptococcus meningioencephalitis See CNS toxoplasmosis associated seizure Monitoring Adverse Events • Infusion of test dose (0.1mg/kg) before initiation of Amphotericin standard dose is important to avoid anaphylactic reaction • A repeat lumbar puncture to ensure clearance of the organism is not required for those with cryptococcal meningitis and improvement in clinical signs and symptoms after initiation of treatment. If new symptoms or clinical findings occur after two weeks of treatment, a repeat lumbar puncture should be performed. • Serial measurement of CSF cryptococcal antigen or culture or Indian ink staining might be more useful but requires repeated lumbar punctures and is not routinely recommended for monitoring response. • Patients treated with amphotericin B should be monitored for dose-dependent nephrotoxicity and electrolyte disturbances. Infusion-related adverse reactions (e.g., fever, chills, renal tubular acidosis, hypokalemia, orthostatic hypotension, tachycardia, nausea, headache, vomiting, anaemia, anorexia, and phlebitis) might be ameliorated by pre-treatment with acetaminophen, diphenhydramine, or corticosteroids administered approximately 30minutes before the infusion. Lipid formulations of amphotericin B are less toxic. Prevention of Recurrence Secondary prevention: Patients who have completed initial therapy for cryptococcosis should be administered lifelong suppressive treatment (i.e. secondary prophylaxis or
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