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Author Topic: Antibiotic Question/Concern  (Read 359 times)

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Offline forty-six

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Antibiotic Question/Concern
« on: November 25, 2020, 12:01:12 am »
In 2016 I was diagnosed with AIDS, the diagnosis was found when I was taken into the ER confused.  The confusion was due to a brain herniation and a diagnosis of Cryptococcal Meningitis in my brain, bones, and spine which put me in the ICU for 17 days and a recovery period of 2.5 years.  My CD4 was 20 when the diagnosis was made.  I was given Amp B to help save my life along with multiple medications. I am now taken Genvoya, I am undetectable and my CD4 is above 500.  However, my infectious disease doctor is not willing to discontinue the antibiotic stating the Crypto can and will come back.  Has anyone else experienced taking antibiotics for such a long period of time and being told you can never stop even though the CD4 is above 200?

Offline Jim Allen

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Re: Antibiotic Question/Concern
« Reply #1 on: November 28, 2020, 11:56:43 am »
Thankfully I've no first-hand experience with cryptococcal-meningitis to offer you.

However, for life being antibiotics to prevent cryptococcal-meningitis prevention really doesn't sound right. I would be seeing another doctor even if it's just to get a second opinion.


How is it treated?

The recommended treatment involves two drugs: amphotericin B (Fungizone) given daily by IV and flucytosine (Ancobon), which is taken by mouth. There are three stages: induction (at least 2 weeks until substantial reduction of symptoms with negative spinal tap), consolidation (at least 8 weeks) and maintenance (up to one year and CD4 count stays above 100).

Amphotericin B can cause side effects, some of them serious. They include nausea, fever, chills, muscle pain, low potassium levels, damage to the bone marrow and its ability to produce red and white blood cells, and kidney damage. Tip: Take a regular dose of acetaminophen (Tylenol, etc.), ibuprofen (Advil, etc.), naproxen (Aleve, etc.) or diphenhydramine (Benadryl, etc.) about a half an hour before receiving amphotericin B to help prevent or reduce some side effects.

Liposomal amphotericin B may be prescribed for those who become very ill while taking the non-liposomal form or who develop kidney problems.

After two weeks of amphotericin B and flucytosine, you will need to have another spinal tap to check for the fungus. If the test is positive, combination treatment will continue. If the test is negative, both drugs are stopped and another drug, fluconazole (Diflucan), is immediately started. This is necessary to help prevent cryptococcal meningitis from recurring. Fluconazole is taken by mouth every day at a dose of 400 mg for at least 8 weeks.

Fluconazole treatment may be stopped after a year of total treatment and if the CD4 count increases to above 100 for at least three months with undetectable viral load in response to HIV treatment. However, some specialists recommend a spinal tap before stopping fluconazole to make sure that there is no detectable fungal infection in the CSF. Fluconazole should be restarted if the CD4 count falls below 100 again.

Because cryptococcal meningitis can cause the brain to swell, which can lead to debilitating symptoms and brain damage, it is often necessary to drain CSF from the spinal column to reduce the amount of pressure in the brain. These spinal taps may need to be repeated daily during the first few weeks of treatment to keep CSF pressure low.

IRIS (immune reconstitution inflammatory syndrome) has been reported in up to 30 percent of people with cryptococcal meningitis—a condition that causes increased symptoms of an opportunistic infection to happen after starting or switching HIV treatment. For this reason, some experts recommend waiting to start HIV treatment until after two weeks and perhaps up to 10 weeks from starting treatment for cryptococcal meningitis.

How is it prevented?

Because Cryptococcus neoformans can be found in many parts of the environment, it is very difficult to prevent coming into contact with it. Moreover, the fungus can live in a person’s body for many months or possibly years before it causes disease, depending on the health of the person’s immune system.

Since the fungus will most likely lead to cryptococcal meningitis in people with low CD4 counts, the best possible way to prevent this disease is to keep the immune system as healthy as possible. This includes starting HIV treatment before the immune system weakens.

For people with CD4 counts below 100, it is possible to take fluconazole once a day to help prevent cryptococcal meningitis and other serious fungal infections. However, most experts don’t recommend this because cryptococcal meningitis is quite rare. Because Cryptococcus neoformans and other fungi can become resistant to long-term use of fluconazole, this would prevent its use when treatment is most needed
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