Treatment
Treatment is divided into 3 stages:
Firstly,induction therapy for 2 weeks.
Secondly,consolidation therapy for 8 weeks.
Lastly,maintenance therapy.
(1)Induction therapy:
Daily prehydration with litre normal saline containing a vial of potassium chloride(given over 2 hours)for 7 days—if there is no potassium chloride with an intravenous drip,patient can take potassium which absorbs slowly three times each day.
Daily amphotericin B 1 mg/kg in a litre 5%dextrose was given at least over 4 hours for 5 days.
Take pills of fluconazole 1200 mg for 14 days
Daily method of spinal taps therapeutic(releasing the CSF up to 20 mL per puncture).
(2)consolidation therapy:
Fluconazole 400 mg/day for 42 days.
(3)maintenance therapy:
fluconazole 200 mg/day for life.
(4)important therapy:
①Patient who has a raised intracranial pressure need daily carry out LP until the intracranial pressure is normal.(https://www.daowen.com)
②If patient deteriorate with severe headache,vomiting,low GCS should recheck opening pressure!
③If patient has a therapy of ARV for more than 6 months already,check viral load for treatment failure.
④If patient has not a therapy of ARV yet,they should start ARV therapy after the commencing the treatment of Cryptococcal Meningitis for one month.(if ARV was started too early,life-threatening IRIS may occur).
⑤If patient is on TB treatment,you should adjust the dose of fluconazole.
Abbreviations
CSF:脑脊液
sub-acute:亚急性的
LP(lumber puncture):腰穿
ARV(antiretroviral):抗反转录病毒药物
GCS(Glasgow come scale):格拉斯哥评分
IRIS(epileptic seizure):癫痫发作
Glasgow coma scale

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