Which antifungal is considered the drug of choice for cryptococcal meningitis?

The drug of choice for cryptococcal meningitis is amphotericin B in combination with fluconazole due to the synergistic effect of these two agents. Amphotericin B is a polyene antifungal that works by binding to ergosterol in the fungal cell membrane, leading to cell lysis. It is particularly effective in the treatment of serious fungal infections, including cryptococcal meningitis, which is often seen in immunocompromised patients such as those with HIV/AIDS.

Fluconazole, an azole antifungal, is also effective against Cryptococcus neoformans, the causative agent of cryptococcal meningitis. Its mechanism of action involves inhibiting fungal cytochrome P450 enzymes, disrupting ergosterol synthesis and thereby compromising the integrity of the fungal cell membrane.

The combination of amphotericin B with fluconazole is often used for initial treatment, especially in severe cases, as it provides an aggressive attack on the infection while also allowing fluconazole to have a role in the long-term management and prevention of relapse after the initial phase of treatment.

Consequently, using this combination not only enhances therapeutic efficacy but also helps in reducing the risk of treatment failure, making it the best choice for managing cryptococ