Show simple item record

dc.contributor.authorLoyse, Angela*
dc.contributor.authorThangaraj, Harry*
dc.contributor.authorEasterbrook, Philippa*
dc.contributor.authorFord, Nathan*
dc.contributor.authorRoy, Monika*
dc.contributor.authorChiller, Tom*
dc.contributor.authorGovender, Nelesh*
dc.contributor.authorHarrison, Thomas S*
dc.contributor.authorBicanic, Tihana*
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.
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
refterms.dateFOA2019-03-04T10:38:43Z
html.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.


Files in this item

Thumbnail
Name:
Loyse Cryptococcal meningitis ...
Size:
107.0Kb
Format:
PDF
Description:
Main article

This item appears in the following Collection(s)

Show simple item record