Which of the following is true about the induction therapy for cryptococcal meningitis?

• A. It includes amphotericin B liposomal as part of the regimen.
• B. It excludes amphotericin B entirely.
• C. It uses fluconazole alone for induction.
• D. It relies on echinocandins.

Answer: (A)

Induction therapy for cryptococcal meningitis relies on rapid fungal clearance by a potent fungicidal agent used in combination with a partner drug. Amphotericin B, given in liposomal form, is included because it delivers strong fungal killing in the CNS and has better tolerability than the traditional formulation, which helps patients complete the regimen when paired with flucytosine. This combination achieves faster cerebrospinal fluid sterilization and lowers mortality, typically given for about 1–2 weeks before moving to consolidation with fluconazole. The idea of excluding amphotericin B, relying on fluconazole alone for induction, or using echinocandins goes against the established approach, since fluconazole alone is not sufficient for induction and echinocandins are not effective against Cryptococcus.