Amphotericin versus Fluconazole in Cryptococcal Meningitis

To the Editor: Saag et al. (Jan. 9 issue)¹ compared intravenous amphotericin B with oral fluconazole in the treatment of cryptococcal meningitis associated with the acquired immunodeficiency syndrome (AIDS). The data reported indicate that patients treated with amphotericin B fared better, albeit not significantly so, in terms of the success rate of treatment, mortality (especially early mortality), length of time to sterilization of the cerebrospinal fluid, and disease progression. Despite these results, the authors conclude that fluconazole is an effective alternative to amphotericin B in cryptococcal meningitis because of the advantages of oral therapy and the lack of significant differences…