Molloy and colleagues in the ACTA trial study team published their results in the New England Journal of Medicine recently. They report that induction therapy for cryptococcal meningitis in the form of amphotericin B and flucytosine for one week, followed by fluconazole plus flucytosine for two weeks was effective in resource-limited settings.

Subsequently the WHO has also published new cryptococcal management guidelines citing this treatment as the preferred induction regimen. However, flucytosine is expensive, not yet registered or easily available in most resource-limited countries and has to be administered four times daily. MSF for instance, has raised concerns about the updated WHO guidelines for these reasons.

See the piece in the NEJM and WHO guidelines.