Question

Which of the following is the treatment of choice for cryptococcal meningitis?

• A. Fluconazole
• B. Itraconazole
• C. Flucytosine
• D. Amphotericin B

Hint:

Cryptococcal meningitis needs a fast fungicidal drug first; amphotericin B is that drug, usually combined with flucytosine, then followed by fluconazole.

Answer 1

The Correct Option is D

Step 1: Understanding the Question:
The question asks for the drug that is the treatment of choice for cryptococcal meningitis, a fungal infection of the brain and its covering caused by Cryptococcus neoformans.

Step 2: Key Formula or Approach:
Cryptococcal meningitis is a serious, life threatening infection seen mostly in patients with weak immunity, such as those with HIV or on long term steroids. The standard approach uses a fast acting fungicidal drug first, then switches to a lighter drug once the infection is under control.

Step 3: Detailed Explanation:
Amphotericin B is fungicidal, it kills the fungus directly by binding to ergosterol in its cell membrane and punching holes in it. Because cryptococcal meningitis can kill quickly if untreated, doctors start with Amphotericin B, often combined with flucytosine, to clear the infection fast, then move the patient to fluconazole for weeks of follow up treatment.
Fluconazole is useful for milder disease and for long term maintenance after the infection is controlled, but on its own it works too slowly to be the first choice in a sick patient.
Itraconazole is not used as first line therapy for this infection because it does not cross into the brain as well as fluconazole or amphotericin B do.
Flucytosine is never used alone, since the fungus can quickly become resistant to it. It is always paired with amphotericin B to boost the killing effect, not used by itself.

Step 4: Final Answer:
Amphotericin B remains the drug of choice to start treatment of cryptococcal meningitis, so the correct option is (D).