Which drug combination constitutes cryptococcal meningitis induction therapy in HIV patients?

• A. Amphotericin B (liposomal) plus flucytosine
• B. Fluconazole monotherapy
• C. Itraconazole plus voriconazole
• D. Amphotericin B deoxycholate alone

Answer: (A)

Induction therapy for cryptococcal meningitis in HIV patients must rapidly reduce fungal burden in the CNS. Amphotericin B acts quickly and is fungicidal against Cryptococcus, and when paired with flucytosine the two work synergistically to clear the organism from the CSF faster than either drug alone. The liposomal form of amphotericin B improves safety, allowing this potent combination to be used during the induction phase without as much risk of kidney toxicity. Fluconazole monotherapy is slower and less effective for induction, so it isn’t the preferred induction regimen. Azole combos like itraconazole plus voriconazole aren’t standard induction therapy and don’t provide the same rapid CSF sterilization. Amphotericin B deoxycholate alone lacks the synergistic effect and is not favored for induction when the liposomal form plus flucytosine is available. Therefore, the combination of amphotericin B (liposomal) plus flucytosine is the correct induction therapy.