Treatment

The mainstay of treatment is combination therapy with an amphotericin-B formulation and flucytosine, recommended in both HIV- and non-HIV-associated infection. (1)

Unwanted effects are common, in particular the blood urea should be monitored; if urea becomes significantly elevated then amphotericin should be stopped until renal function improves.

For patients with HIV, the World Health Organization recommends an induction regimen that consists of a single high dose of liposomal amphotericin-B combined with 14 days of flucytosine and fluconazole. (2) Where liposomal amphotericin-B is not available, the WHO recommends 1 week of amphotericin-B deoxycholate and flucytosine, followed by 1 week of fluconazole. (2)

Reference

1. National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association of the Infectious Disease Society of America. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV. Jul 2025 [internet publication].
2. World Health Organization. Guidelines for diagnosing, preventing and managing cryptococcal disease among adults, adolescents and children living with HIV. June 2022 [internet publication].