Featured Research

from universities, journals, and other organizations

Change in treatment regime for cryptococcal meningitis may be needed, study finds

Date:
September 25, 2012
Source:
Public Library of Science
Summary:
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 (WHO), warranting a review of policy, according to the findings of a new study.

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 (WHO), warranting a review of policy, according to the findings of a study published in this week's PLOS Medicine.

Researchers from Makerere University in Kampala, Uganda, and from the University of Minnesota in the US 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, WHO recommends a 14-day regimen of injected amphotericin (a very toxic drug) and oral flucytosine or fluconazole for induction therapy of cryptococcal meningitis, but this regimen is impractical in many low income countries because of the cost of the drugs and hospital admission; so high-dose fluconazole alone is the usual treatment, even though this regimen is much less effective resulting in more deaths.

The authors say: "Short-course (7-day) amphotericin induction therapy coupled with high-dose fluconazole is very cost effective per World Health Organization criteria and may be a worthy investment for policy-makers seeking cost effective clinical outcomes."

They add: "Amphotericin should be moved from the ''complementary list'' to the ''core list'' in the WHO Model List of Essential Medications."

In an accompanying Perspective article, Andrew Farlow from the University of Oxford (uninvolved in the study) says that two results stand out: "First, the least cost-effective regimen is high-dose fluconazole monotherapy, which has been associated with a nearly 2-fold higher 10- week mortality rate and about 30% greater absolute mortality than the short course (5 days) amphotericin-based regimen. Second, long-course (14 days) amphotericin-based regimens, as recommended by the World Health Organization are not only more costly but appear to be no more effective than short course amphotericin-based regimens."

Farlow adds: "If the second finding is confirmed in further trials, the World Health Organization will need to adjust its advice."


Story Source:

The above story is based on materials provided by Public Library of Science. Note: Materials may be edited for content and length.


Journal References:

  1. Rajasingham R, Rolfes MA, Birkenkamp KE, Meya DB, Boulware DR. Cryptococcal Meningitis Treatment Strategies in Resource-Limited Settings: A Cost-Effectiveness Analysis. PLOS Medicine, 2012; 9 (9): e1001316 DOI: 10.1371/journal.pmed.1001316
  2. Farlow AWK. The Challenges and Possibilities of Reducing Deaths from Cryptococcal Meningitis in Sub-Saharan Africa. PLOS Medicine, 2012; 9 (9): e1001318 DOI: 10.1371/journal.pmed.1001318

Cite This Page:

Public Library of Science. "Change in treatment regime for cryptococcal meningitis may be needed, study finds." ScienceDaily. ScienceDaily, 25 September 2012. <www.sciencedaily.com/releases/2012/09/120925171446.htm>.
Public Library of Science. (2012, September 25). Change in treatment regime for cryptococcal meningitis may be needed, study finds. ScienceDaily. Retrieved October 1, 2014 from www.sciencedaily.com/releases/2012/09/120925171446.htm
Public Library of Science. "Change in treatment regime for cryptococcal meningitis may be needed, study finds." ScienceDaily. www.sciencedaily.com/releases/2012/09/120925171446.htm (accessed October 1, 2014).

Share This



More Health & Medicine News

Wednesday, October 1, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Ebola Cases Keep Coming for Monrovia's Island Hospital

Ebola Cases Keep Coming for Monrovia's Island Hospital

AFP (Oct. 1, 2014) — A look inside Monrovia's Island Hospital, a key treatment centre in the fight against Ebola in Liberia's capital city. Duration: 00:34 Video provided by AFP
Powered by NewsLook.com
Ebola Puts Stress on Liberian Health Workers

Ebola Puts Stress on Liberian Health Workers

AP (Oct. 1, 2014) — The Ebola outbreak is putting stress on first responders in Liberia. Ambulance drivers say they are struggling with chronic shortages of safety equipment and patients who don't want to go to the hospital. (Oct. 1) Video provided by AP
Powered by NewsLook.com
Doctors Reassure Public Ebola Patient Won't Cause Outbreak

Doctors Reassure Public Ebola Patient Won't Cause Outbreak

Newsy (Sep. 30, 2014) — After the announcement that the first U.S. patient had been diagnosed with Ebola, doctors were quick to say a U.S. outbreak is highly unlikely. Video provided by Newsy
Powered by NewsLook.com
TX Hospital Confirms Patient Admitted With Ebola

TX Hospital Confirms Patient Admitted With Ebola

AP (Sep. 30, 2014) — Medical officials from Texas Health Presbyterian Hospital confirm they are treating a patient with the Ebola virus, the first case found in the US. (Sept. 30 Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:

Strange & Offbeat Stories

 

Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins