American Board of Internal Medicine (ABIM) Certification Practice Exam

During the consolidation period of cryptococcal meningitis treatment, what is the recommended regimen?

1. Amphotericin B

2. No treatment indicated

3. Oral fluconazole for 8 weeks

4. Itraconazole for 6-12 months

The correct answer is: Oral fluconazole for 8 weeks

The recommended regimen during the consolidation period of cryptococcal meningitis treatment is oral fluconazole for 8 weeks. This phase follows initial induction therapy, typically with amphotericin B and flucytosine, which effectively reduces the fungal burden. During consolidation, the goal is to further decrease the risk of relapse and to allow for sustained suppression of cryptococcal infection. Oral fluconazole is preferred because it is an azole antifungal that has good CNS penetration and is effective against Cryptococcus neoformans, the causative organism of cryptococcal meningitis. The 8-week duration is evidence-based, reflecting studies that show this duration reduces the risk of relapse while being well-tolerated and manageable for patients. In contrast, amphotericin B is typically used in the induction phase due to its potency, but it is not used for consolidation due to its toxicity and infusion-related side effects. No treatment indicated is not appropriate as ongoing management is essential to prevent relapse. Itraconazole is not typically used for cryptococcal meningitis; it has less efficacy against this organism compared to fluconazole, and its prolonged treatment window does not align with the guidelines established for managing cryptococcal infections. Therefore, the choice