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Expert Alert

In the fight against cryptococcal meningitis, U of M researcher recommends a shorter, more cost-effective therapy regimen

October 9, 2012

The most cost-effective course of treatment for cryptococcal meningitis is different than current World Health Organization (WHO) recommendations according to University of Minnesota researchers, and as a result, current policies need to be reviewed. 

A University of Minnesota expert who can speak to current and potential meningitis treatment recommendations, and discuss a shorter, cost-effective therapy regimen option for cryptococcal meningitis is:

David Boulware, M.D., M.P.H., Associate Director of Global Health Programs in Internal Medicine, Division of Infectious Diseases & International Medicine, Department of Medicine.

Cryptococcal meningitis is a serious fungal infection of the brain, usually occurring in people with immune system deficiencies such as organ transplantation or HIV/AIDS. Cryptococcal meningitis affects approximately 1 million people per year worldwide and is currently the most common cause of meningitis in Africa.

In recent PLoS Medicine findings, researchers from the University of Minnesota and Makerere University in Kampala, Uganda, outline how a one week course of amphotericin (an intravenous anti-fungal medication) along with high-dose oral fluconazole for at least two weeks could still cure patients of cryptococcal meningitis as effectively as the current WHO recommendations: a 14-day regimen of injected amphotericin (a toxic medication) and oral flucytosine or fluconazole.

But the regimen recommended by the WHO is impractical in many low-income countries because of the cost of the drugs and drug toxicity, so a less-effective regimen of high-dose oral fluconazole alone has become the most common treatment, even though this less effective regimen results in 30 percent more deaths. 

“Short-course (7-day) amphotericin induction therapy coupled with high-dose fluconazole is a cost-effective treatment option per World Health Organization criteria and may be a worthy investment for policy-makers seeking cost-effective clinical outcomes,” said Boulware. “Although our treatment recommendations are slightly more costly than oral fluconazole alone, the overall survival rates are approximately 30 percent better and our recommendations are much less expensive than what the WHO is currently recommending.

The problem, according to Boulware, is that currently, amphotericin is not widely available in most African countries.

“The WHO should include amphotericin on its ‘core list’ of Essential Medications, and advocate for making this therapy available to more people in low-income countries around the world,” he said.

A complete summary of the findings can be found by visiting the PLOS Medicine report below.

To interview Boulware or for more information contact Matt DePoint at (612) 625-4110 or

Tags: Academic Health Center

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