What is the first-line suppressive therapy for cryptococcal meningitis?

The first-line suppressive therapy for cryptococcal meningitis is fluconazole. This medication is particularly effective in lowering the fungal burden and preventing recurrence after an initial treatment phase. Fluconazole has several advantages, including good oral bioavailability, a favorable safety profile, and the ability to penetrate the central nervous system. These properties make it a practical choice for long-term suppression in patients who have had cryptococcal meningitis.

While itraconazole is an antifungal agent as well, it is not typically used for cryptococcal meningitis due to its lower efficacy against Cryptococcus neoformans. Voriconazole, although effective against certain fungal infections, is not standard treatment for cryptococcal meningitis and is typically reserved for other conditions, such as invasive aspergillosis. Amphotericin B is used for the initial treatment of severe cryptococcal meningitis and is effective at rapidly reducing fungal counts, but it is not utilized for long-term suppressive therapy because of its toxicity and side effect profile. Therefore, fluconazole is the preferred agent for ongoing management in this context.