What is the recommended treatment for Cryptococcus neoformans meningitis?

The recommended treatment for Cryptococcus neoformans meningitis is typically a combination of Amphotericin B and flucytosine. This regimen is considered the first-line therapy due to its effectiveness in penetrating the central nervous system and its ability to reduce the fungal load significantly.

Amphotericin B is a potent antifungal that acts by binding to ergosterol in the fungal cell membrane, creating pores and leading to cell death. When used in conjunction with flucytosine, which inhibits nucleic acid synthesis, the combination enhances therapeutic efficacy. Flucytosine enters fungal cells and is converted to 5-fluorouracil, which interferes with RNA and DNA synthesis, further aiding in the treatment of the infection. This combination is particularly important in severe cases, such as cryptococcal meningitis in immunocompromised patients, as it helps to quickly reduce the fungal burden and manage elevated intracranial pressure.

Other treatment options, such as fluconazole, may be used for mild or less severe cases or as maintenance therapy following the initial treatment. However, they are generally not the first choice for acute cryptococcal meningitis due to their lower efficacy in penetrating into the central nervous system when compared to