Cryptococcal meningitis: improving access to essential antifungal medicines in resource-poor countries

Hdl Handle:
http://hdl.handle.net/10144/295248
Title:
Cryptococcal meningitis: improving access to essential antifungal medicines in resource-poor countries
Authors:
Loyse, Angela; Thangaraj, Harry; Easterbrook, Philippa; Ford, Nathan; Roy, Monika; Chiller, Tom; Govender, Nelesh; Harrison, Thomas S; Bicanic, Tihana
Journal:
The Lancet Infectious Diseases
Abstract:
Cryptococcal meningitis is the leading cause of adult meningitis in sub-Saharan Africa, and contributes up to 20% of AIDS-related mortality in low-income and middle-income countries every year. Antifungal treatment for cryptococcal meningitis relies on three old, off-patent antifungal drugs: amphotericin B deoxycholate, flucytosine, and fluconazole. Widely accepted treatment guidelines recommend amphotericin B and flucytosine as first-line induction treatment for cryptococcal meningitis. However, flucytosine is unavailable in Africa and most of Asia, and safe amphotericin B administration requires patient hospitalisation and careful laboratory monitoring to identify and treat common side-effects. Therefore, fluconazole monotherapy is widely used in low-income and middle-income countries for induction therapy, but treatment is associated with significantly increased rates of mortality. We review the antifungal drugs used to treat cryptococcal meningitis with respect to clinical effectiveness and access issues specific to low-income and middle-income countries. Each drug poses unique access challenges: amphotericin B through cost, toxic effects, and insufficiently coordinated distribution; flucytosine through cost and scarcity of registration; and fluconazole through challenges in maintenance of local stocks-eg, sustainability of donations or insufficient generic supplies. We advocate ten steps that need to be taken to improve access to safe and effective antifungal therapy for cryptococcal meningitis.
Affiliation:
Cryptococcal Meningitis Group, Research Centre for Infection and Immunity, Division of Clinical Sciences, St George's University of London, UK.
Publisher:
Elsevier
Issue Date:
31-May-2013
URI:
http://hdl.handle.net/10144/295248
DOI:
10.1016/S1473-3099(13)70078-1
PubMed ID:
23735626
Submitted date:
2013-06-20
Language:
en
ISSN:
1474-4457
Appears in Collections:
Other Diseases

Full metadata record

DC FieldValue Language
dc.contributor.authorLoyse, Angelaen_GB
dc.contributor.authorThangaraj, Harryen_GB
dc.contributor.authorEasterbrook, Philippaen_GB
dc.contributor.authorFord, Nathanen_GB
dc.contributor.authorRoy, Monikaen_GB
dc.contributor.authorChiller, Tomen_GB
dc.contributor.authorGovender, Neleshen_GB
dc.contributor.authorHarrison, Thomas Sen_GB
dc.contributor.authorBicanic, Tihanaen_GB
dc.date.accessioned2013-07-04T20:40:19Z-
dc.date.available2013-07-04T20:40:19Z-
dc.date.issued2013-05-31-
dc.date.submitted2013-06-20-
dc.identifier.citationCryptococcal meningitis: improving access to essential antifungal medicines in resource-poor countries. 2013: Lancet Infect Disen_GB
dc.identifier.issn1474-4457-
dc.identifier.pmid23735626-
dc.identifier.doi10.1016/S1473-3099(13)70078-1-
dc.identifier.urihttp://hdl.handle.net/10144/295248-
dc.description.abstractCryptococcal meningitis is the leading cause of adult meningitis in sub-Saharan Africa, and contributes up to 20% of AIDS-related mortality in low-income and middle-income countries every year. Antifungal treatment for cryptococcal meningitis relies on three old, off-patent antifungal drugs: amphotericin B deoxycholate, flucytosine, and fluconazole. Widely accepted treatment guidelines recommend amphotericin B and flucytosine as first-line induction treatment for cryptococcal meningitis. However, flucytosine is unavailable in Africa and most of Asia, and safe amphotericin B administration requires patient hospitalisation and careful laboratory monitoring to identify and treat common side-effects. Therefore, fluconazole monotherapy is widely used in low-income and middle-income countries for induction therapy, but treatment is associated with significantly increased rates of mortality. We review the antifungal drugs used to treat cryptococcal meningitis with respect to clinical effectiveness and access issues specific to low-income and middle-income countries. Each drug poses unique access challenges: amphotericin B through cost, toxic effects, and insufficiently coordinated distribution; flucytosine through cost and scarcity of registration; and fluconazole through challenges in maintenance of local stocks-eg, sustainability of donations or insufficient generic supplies. We advocate ten steps that need to be taken to improve access to safe and effective antifungal therapy for cryptococcal meningitis.en_GB
dc.languageENG-
dc.language.isoenen
dc.publisherElsevieren_GB
dc.rightsPublished by Elsevier Reproduced on this site with permission of Elsevier Ltd. Please see [url]http://www.thelancet.com/journals/laninf[/url] for further relevant comment.en_GB
dc.subjectHealth Policy/Access to Medicineen_GB
dc.subjectHIV/AIDSen_GB
dc.subjectInfections, Otheren_GB
dc.titleCryptococcal meningitis: improving access to essential antifungal medicines in resource-poor countriesen
dc.contributor.departmentCryptococcal Meningitis Group, Research Centre for Infection and Immunity, Division of Clinical Sciences, St George's University of London, UK.en_GB
dc.identifier.journalThe Lancet Infectious Diseasesen_GB

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