Fluconazole donation and outcomes assessment in cryptococcal meningitis
Collett, G.; Parrish, A.
South African Medical Journal 97(3): 175-176
2007
ISSN/ISBN: 0256-9574 PMID: 17440660 Document Number: 607462
The aim of this study was to assess the trends in amphotericin B (AmpB) usage in the East London Hospital Complex (ELHC) in South Africa and the fluconazole availability at a district level. Between January 2003 and December 2005, 629 HIV-infected patients (mean age, 34.5+or-8.98 years; 309 from hospital A and 1320 from hospital B) were started on suppressive fluconazole therapy (200 mg daily) for cryptococcal meningitis. Only 198 (31.5%) patients returned at 2 months of outpatient therapy, and at 4 months, 77% of patients did not return for repeat scripts. Using failure to return for a further script as a surrogate for outcome, a Cox proportional hazards model was generated to compare outcomes between the 2 hospitals in the light of the differential use of AmpB as initial therapy. During 2004, AmpB was given to 91% of patients with cryptococcal meningitis at hospital A and to 56% at hospital B. The use of fluconazole in the ELHC drainage region doubled during the study period, but even if all fluconazole dispensed at other sites was given entirely to patients initially managed at the ELHC, there would only have been sufficient fluconazole dispensed to treat patients for 7.3 months in 2003, 5.2 months in 2004, and 4.4 months in 2005. Only 62 patients were started on antiretroviral therapy during the study period; 3.7% of those receiving fluconazole in 2003, 10.1% in 2004, and 16.6% in 2005. The implications of these results are discussed.