Voriconazole plus flucytosine is not superior to amphotericin B deoxycholate plus flucytosine as an induction regimen for cryptococcal meningitis treatment

Abstract Background The efficacy and side effects of voriconazole plus 5‐flucytosine (Vori + 5‐FC) versus amphotericin B deoxycholate plus 5‐flucytosine (AmBd + 5‐FC) as an induction treatment for cryptococcal meningitis are unknown. Methods Forty‐seven patients treated with Vori + 5‐FC and 92 patients treated with AmBd + 5‐FC were included in the current study after propensity score matching (PSM) at a ratio of 1:2. Two‐week laboratory test results and 90‐day mortality were compared between the two groups. Results After 2 weeks of induction treatment, the CSF Cryptococcus sterile culture rate was 57.1% in the Vori + 5‐FC group and 76.5% in the AmBd + 5‐FC group ( p = .026). No difference was found in the normalization of CSF indicators (glucose, total protein, intracranial pressure and India ink sterile rate) between the two groups. Both the Vori + 5FC regimen and AmBd + 5‐FC regimen obviously decreased haemoglobin concentrations, platelet counts and serum potassium levels (all p ≤ .010). Notably, the Vori + 5FC regimen did not influence serum creatinine levels ( p = .263), while AmBd + 5FC increased serum creatinine levels ( p = .019) after 2‐week induction treatment. The Vori + 5‐FC group and AmBd + 5‐FC group had similar 90‐day cumulative survival rates (89.9% vs. 87.8%, p = .926). Conclusion The Vori + 5‐FC regimen was associated with low 2‐week CSF sterile culture and was not superior to AmBd + 5‐FC as induction therapy in terms of the 90‐day cumulative survival rate of CM patients.