What is the first-line treatment for cryptococcal meningitis?

The first-line treatment for cryptococcal meningitis is IV amphotericin and/or flucytosine. This approach is a standard in clinical practice, particularly for such a severe fungal infection. Amphotericin B is a potent antifungal agent that works by binding to ergosterol in the fungal cell membrane, leading to increased permeability and ultimately cell death. Flucytosine, when used in conjunction with amphotericin B, acts synergistically to enhance antifungal efficacy. This combination therapy is critical in managing cryptococcal meningitis because it effectively decreases fungal load and improves patient outcomes, especially in immunocompromised individuals, such as those with HIV/AIDS.

Oral antifungals are not considered the first-line treatment for cryptococcal meningitis because they do not provide the rapid and robust response needed for severe central nervous system infections. Corticosteroids can be useful in managing inflammatory responses, particularly regarding complications like cerebral edema, but they do not address the underlying fungal infection and are not used as primary treatment. Symptomatic medications may support patients by alleviating some symptoms but do not treat the infection itself and are not a replacement for antifungal therapy. Thus, the use of IV amphotericin and/or flucyt