American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the maintenance treatment duration for cryptococcal meningitis?

1. 4 weeks

2. 6-12 months

3. 8 weeks

4. 12-24 months

The correct answer is: 6-12 months

The maintenance treatment duration for cryptococcal meningitis is typically 6-12 months. This duration is essential to effectively reduce the risk of relapse in patients, particularly those with underlying immunosuppression such as HIV/AIDS. After the initial induction therapy, which often consists of a high-dose antifungal regimen typically using amphotericin B combined with flucytosine for 2 weeks, the transition to maintenance therapy is crucial. The maintenance phase uses fluconazole, usually at a reduced dose, and helps to prevent the recurrence of the infection. The recommendation for a maintenance treatment duration of 6-12 months is supported by clinical studies showing that this timeframe is effective in preventing relapse while ensuring that patients with compromised immune systems are adequately managed. Following this period, patients should be evaluated for any signs of recurrence and their immune status should be monitored, especially in cases of HIV, where ongoing antiretroviral therapy is also important. This long maintenance treatment phase reflects the chronic nature of cryptococcal infections in immunocompromised individuals and the necessity for prolonged antifungal therapy to achieve sustained remission.