Evidence behind the WHO guidelines: what is the most appropriate anti-fungal treatment for acute cryptococcal meningitis in children with HIV?

Abstract

The World Health Organization has produced guidelines for the management of common illnesses in hospitals with limited resources. This series reviews the scientific evidence behind WHO’s recommendations. The WHO guidelines and more reviews are available at: http://www.ichrc.org. The WHO Pocketbook of Hospital Care for Children [1] recommends treating children with cryptococcal meningitis with intravenous amphotericin B (0.5–1.5 mg kg−1 day−1) for 14 days followed by oral fluconazole (3–6 mg kg−1 day−1) for 8 weeks. Following the management of an acute episode, current recommendations advise ongoing prophylaxis with fluconazole. This review addresses the question: what is the most appropriate anti-fungal treatment for acute cryptococcal meningitis in children with HIV?