Infectious Diseases Physician Management of Cryptococcal Meningitis in North America—Is Single High-Dose Liposomal Amphotericin B Being Used?

Nathan C Bahr; Susan E Beekmann; Philip M Polgreen; Jeremey B Walker; Andrej Spec; David R Boulware; John W Baddley

doi:10.1093/ofid/ofae120

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Infectious Diseases Physician Management of Cryptococcal Meningitis in North America—Is Single High-Dose Liposomal Amphotericin B Being Used?

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Infectious Diseases Physician Management of Cryptococcal Meningitis in North America—Is Single High-Dose Liposomal Amphotericin B Being Used?

Nathan C Bahr, Susan E Beekmann, Philip M Polgreen, Jeremey B Walker, Andrej Spec, David R Boulware and John W Baddley

Open forum infectious diseases, Vol.11(6), p.ofae120

06/03/2024

DOI: 10.1093/ofid/ofae120

PMCID: PMC11181173

PMID: 38887490

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Abstract

Background Several recent randomized trials have been conducted in resource-limited settings for cryptococcal meningitis that have rapidly innovated international guidelines. The 2010 Infectious Diseases Society of America (IDSA) cryptococcal meningitis guideline has not been updated with recent trials. The 2022 AMBITION-cm trial found that a single 10-mg/kg dose of liposomal amphotericin B plus daily flucytosine and fluconazole for 2 weeks was noninferior to 1 week of amphotericin B deoxycholate with flucytosine. It is unknown whether physicians in high-resource settings are using this regimen or more traditional regimens. Methods We developed an electronic survey in June 2023 to better understand whether physician members of the IDSA Emerging Infections Network (EIN) and Mycoses Study Group Education and Research Consortium (MSG-ERC) had used the AMBITION-cm induction regimen, would use the regimen in hypothetical clinical scenarios, and what perceived barriers to use existed. Results A total of 242 of 561 (43%) physicians responded to the survey, of whom 205 provided care for persons with cryptococcal meningitis in the last year. Overall, 29 (14%) had used the AMBITION-cm regimen, and 176 (86%) had not. In various hypothetical clinical scenarios, only âˆ¼10% of 209 respondents selected the AMBITION-cm regimen as preferred. Perceived barriers to uptake included the applicability of trials performed in low-resource settings to high-resource settings, that the regimen is not recommended in the 2010 IDSA guidelines, and the applicability to persons without HIV. Conclusions Most respondents had not used the single-dose liposomal amphotericin B regimen, but the regimen is being used. Further study of this regimen in other patient populations and settings is necessary.

Organ Transplantation

cryptococcal meningitis

cryptococcosis

HIV/AIDS

Details

Title: Subtitle: Infectious Diseases Physician Management of Cryptococcal Meningitis in North America—Is Single High-Dose Liposomal Amphotericin B Being Used?
Creators: Nathan C Bahr - University of Kansas
Susan E Beekmann - University of Iowa
Philip M Polgreen - University of Iowa, Infectious Diseases
Jeremey B Walker - University of Alabama at Birmingham
Andrej Spec - Washington University in St. Louis
David R Boulware - University of Minnesota
John W Baddley - University of Maryland, Baltimore
Resource Type: Journal article
Publication Details: Open forum infectious diseases, Vol.11(6), p.ofae120
DOI: 10.1093/ofid/ofae120
PMID: 38887490
PMCID: PMC11181173
NLM abbreviation: Open Forum Infect Dis
ISSN: 2328-8957
eISSN: 2328-8957
Publisher: Oxford University Press
Grant note: This work was supported by Cooperative Agreement Number NU50 CK000574, funded by the Centers for Disease Control and Prevention.
Language: English
Date published: 06/03/2024
Academic Unit: Infectious Diseases; Epidemiology; Injury Prevention Research Center; Internal Medicine
Record Identifier: 9984650758902771

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