Change in treatment regime for cryptococcal meningitis may be needed

The most cost-effective treatment for cryptococcal meningitis (a serious infection of the brain membranes, usually in people with AIDS or other immune system deficiencies) is different to that currently recommended by the World Health Organization, warranting a review of policy, according to the findings of a study published in this weekÔÇÖs PLOS Medicine.

Researchers from Makerere University in Kampala, Uganda, and from the University of Minnesota in the USA found that a short (7-day) course of amphotericin along with high-dose fluconazole for at least 2 weeks is the most cost-effective and least toxic treatment for cryptococcal meningitis.

The authors reached their conclusions by calculating the overall cost of six induction treatments for cryptococcal meningitis in HIV-infected patients using 2012 healthcare costs in Uganda for drugs, supplies, and hospital care, and average laboratory costs for monitoring treatment from three African countries. Then they estimated the survival, cost and cost per benefit associated with each treatment.

Currently, the World Health Organization (WHO) recommends a 14-day regimen of injected amphotericin (a very toxic drug) and oral flucytosine or fluconazole for induction therapy of cryptococcus meningitis but this regimen is impractical in many poor countries because of the cost of the drugs and hospital admission: so high-dose fluconazole monotherapy is the usual treatment, even though this regimen is much less effective.

The authors say: ÔÇ£Short-course (7-day) amphotericin induction therapy coupled with high-dose fluconazole is ÔÇÿvery cost effective per World Health Organization criteria and may be a worthy investment for policy-makers seeking cost effective clinical outcomes.ÔÇØ
They add: ÔÇ£Amphotericin should be moved from the ÔÇÿÔÇÿcomplementary listÔÇÖÔÇÖ to the ÔÇÿÔÇÿcore listÔÇÖÔÇÖ in the WHO Model List of Essential Medications.ÔÇØ

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Ms. Milly Nattimba, Communication Officer, College of Health Sciences, Tel: +256-782-549387, Email: pr@chs.mak.ac.ug, Web: http://chs.mak.ac.ug

Dr. David Meya, Department of Medicine, School of Medicine, College of Health Sciences, Tel: +256-772-543730, Email: david.meya@gmail.comWeb: http://chs.mak.ac.ug