Recent advances in the diagnosis and management of
cryptococcal meningitis are promising and have been improving long-term survival. Point of care testing has made diagnosing
cryptococcal meningitis rapid, practical, and affordable. Targeted screening and treatment programs for cryptococcal antigenemia are a cost effective method for reducing early mortality on antiretroviral
therapy (ART). Optimal initial management with
amphotericin and
flucytosine improves survival against
alternative therapies, although
amphotericin is difficult to administer and
flucytosine is not available in middle or low income countries, where
cryptococcal meningitis is most prevalent. Controlling increased intracranial pressure with serial therapeutic lumbar punctures has a proven survival benefit. Delaying ART initiation for 4 weeks after the diagnosis of
cryptococcal meningitis is associated with improved survival. Fortunately, new approaches have been leading the way toward improving care for
cryptococcal meningitis patients. New trials utilizing different combinations of antifungal
therapy are reviewed, and we summarize the efficacy of different regimens.