American Board of Internal Medicine (ABIM) Certification Practice Exam

In patients with AIDS, what is the recommended induction treatment for cryptococcal meningitis?

1. Oral fluconazole

2. Amphotericin B and flucytosine

3. High-dose amphotericin B

4. Mucormycosis therapy

The correct answer is: Amphotericin B and flucytosine

In patients with AIDS who develop cryptococcal meningitis, the recommended induction treatment involves the combination of amphotericin B and flucytosine. This regimen is preferred because it has been shown to offer the most effective antifungal coverage and achieve better outcomes in critically ill patients. Amphotericin B is a potent antifungal that works by binding to ergosterol in fungal cell membranes, leading to increased permeability and cell death. Its effectiveness is particularly important in managing severe fungal infections like cryptococcal meningitis. Combined with flucytosine, which interferes with fungal DNA and RNA synthesis, this treatment enhances the overall antifungal activity. Flucytosine is particularly effective when used in conjunction with amphotericin B, as it can penetrate the central nervous system well, an essential factor in treating meningitis. This dual therapy not only helps in clearing the organism from the central nervous system but also in reducing the risk of resistance development, thus ensuring better long-term outcomes. While alternatives like high-dose amphotericin B alone could be considered, they do not provide the synergistic benefits seen with the combination therapy. Other options listed do not align with the current treatment protocols for cryptococcal meningitis in the context of