Dexamethasone in Cryptococcal Meningitis

Concurrent Medication:

Allowed:

• Aerosolized pentamidine or systemic chemoprophylaxis for PCP.
• Preventive therapy for steroid-associated ulcers and any other therapies required to manage steroid toxicity (e.g., insulin).

Patients must have:

• Documented initial episode or relapse of acute cryptococcal meningitis. (NOTE: Patients must be untreated for this episode except for administration of a test dose of 1 g or less amphotericin B.)
• Acute cryptococcal meningitis with cerebrospinal fluid opening pressure >= 250 mm H2O prior to receipt of antifungal therapy for this episode.
• Documented HIV infection OR a diagnosis of AIDS based on a documented AIDS-defining opportunistic infection.
• Ability to begin therapy within 8 hours after the pre-entry lumbar puncture.
• Consent of parent or guardian if less than 18 years of age.

NOTE:

• Comatose patients eligible provided informed consent can be provided by guardian or next of kin.

Exclusion Criteria

Co-existing Condition:

Patients with the following symptoms or conditions are excluded:

• Concurrent CNS disease such as another infection or neoplasm that would interfere with assessment of response.
• Prison incarceration.

Concurrent Medication:

Excluded:

• Acetazolamide, mannitol, urea preparations, and other corticosteroids during the first 72 hours of the study.
• Treatment or prophylaxis with other systemic antifungal agents at any time.
• Antiretroviral therapy during the first 72 hours of the study.

Prior Medication:

Excluded within 7 days prior to study entry:

• Corticosteroids, mannitol, urea preparations, acetazolamide, or more than 24 hours of phenytoin.