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Cochrane Database of Systematic Reviews

Treatment of acute cryptococcal meningitis in HIV infected adults, with an emphasis on resource-limited settings

Overview of attention for article published in Cochrane database of systematic reviews, October 2008
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About this Attention Score

  • Good Attention Score compared to outputs of the same age (69th percentile)

Mentioned by

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1 Facebook page
wikipedia
4 Wikipedia pages

Citations

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45 Dimensions

Readers on

mendeley
142 Mendeley
Title
Treatment of acute cryptococcal meningitis in HIV infected adults, with an emphasis on resource-limited settings
Published in
Cochrane database of systematic reviews, October 2008
DOI 10.1002/14651858.cd005647.pub2
Pubmed ID
Authors

Derek Sloan, Sipho Dlamini, Navin Paul, Martin Dedicoat

Abstract

Despite the advent and increasingly wide availability of antiretroviral therapy, cryptococcal meningitis (CM) remains a significant cause of mortality and morbidity amongst individuals with HIV infection in resource-limited settings. The ideal management of CM remains unclear. The aim of this review is to assess the evidence for deciding on which antifungal regimen to use as well as other modalities of management to utilise especially resource poor settings in order to achieve the best possible outcome and enable an individual with CM to survive their acute illness and benefit from antiretroviral therapy. To determine the most effective initial and consolidation treatment strategy for CM in HIV infected adults. The Cochrane HIV/AIDS group search strategy was used. Key words in the search included, meningitis, cryptococcus neoformans, treatment, trial, human immunodeficiency virus, acquired immunodeficiency syndrome, antifungal agents, amphotericin, flucytosine, fluconazole, azole, lumbar puncture, cerebrospinal fluid (CSF) pressure and acetazolamide. Randomised of HIV-infected adults with a first episode of CM diagnosed on CSF examination, by India ink staining, CSF culture or cryptococcal antigen testing. Data were extracted using standardised forms and analysed using Rev Man 4.2.7 software. Six studies are included in the review. Five of the studies compared antifungal treatments and one study addressed lowering intracranial pressure. This study was stopped early due to excess adverse effects. The results of the other five studies as summarised as follows.Mayanja-Kizza 1998 compared fluconazole to fluconazole with 5 flucytosine. The dose of fluconazole used 200mg initially is lower than the recommended initial dose of 400mg. No survival advantage was found with the use of 5 flucytosine in addition to fluconazole.Two studies Brouwer 2004 and van der Horst 1997 compared Amphotericin (AmB) to AmB with 5 flucytosine. Both drugs were given at currently recommended doses for 2 weeks. No survival difference was found at 14 days or at 10 weeks (only recorded in Brouwer 2004). There were significantly more patients with sterile CSF cultures at 14 days in the group that received AmB with flucytosine.Brouwer 2004 compared AmB given alone to AmB given with flucytosine and fluconazole alone or in combination. This was a small study and no differences in mortality were noted between the groups.Bicanic 2008 compared high to standard dose AmB both with flucytosine. There was no difference in mortality between the two groups or adverse events.Leenders 1997 compared standard AmB to liposomal AmB. There was no difference in death rates between the two groups. But there were significantly fewer side effects in the group treated with liposomal AmB. The main aim of this review was to determine the best treatment for cryptococcal meningitis in resource-limited settings. In these settings usually only AmB and fluconazole are available. No studies suitable for inclusion in the review were found that compared these two drugs. Therefore we are unable to recommend either treatment as superior to the other. The recommended treatment for CM is a combination of AmB and flucytosine. The optimal dosing of AmB remains unclear. Liposomal AmB is associated with less adverse events than AmB and may be useful in selected patients where resources allow.Future research into the management of cryptococcal meningitis in resource-limited settings should focus on the most effective use of medications that are available in these settings.Flucytosine in combination with AmB leads to faster and increased sterilisation of CSF compared to using AmB alone. As Flucytosine is often not available in developing countries, policy makers and national departments of heath should consider procuring this drug for HIV treatment programmes.

Mendeley readers

The data shown below were compiled from readership statistics for 142 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Tanzania, United Republic of 2 1%
France 1 <1%
Mexico 1 <1%
Brazil 1 <1%
Unknown 137 96%

Demographic breakdown

Readers by professional status Count As %
Student > Master 24 17%
Researcher 22 15%
Student > Ph. D. Student 18 13%
Student > Postgraduate 16 11%
Student > Bachelor 10 7%
Other 32 23%
Unknown 20 14%
Readers by discipline Count As %
Medicine and Dentistry 86 61%
Agricultural and Biological Sciences 7 5%
Immunology and Microbiology 5 4%
Nursing and Health Professions 4 3%
Social Sciences 3 2%
Other 12 8%
Unknown 25 18%

Attention Score in Context

This research output has an Altmetric Attention Score of 4. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 15 June 2018.
All research outputs
#5,715,525
of 18,110,549 outputs
Outputs from Cochrane database of systematic reviews
#8,076
of 11,816 outputs
Outputs of similar age
#89,075
of 301,675 outputs
Outputs of similar age from Cochrane database of systematic reviews
#176
of 243 outputs
Altmetric has tracked 18,110,549 research outputs across all sources so far. This one has received more attention than most of these and is in the 67th percentile.
So far Altmetric has tracked 11,816 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 25.5. This one is in the 30th percentile – i.e., 30% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 301,675 tracked outputs that were published within six weeks on either side of this one in any source. This one has gotten more attention than average, scoring higher than 69% of its contemporaries.
We're also able to compare this research output to 243 others from the same source and published within six weeks on either side of this one. This one is in the 27th percentile – i.e., 27% of its contemporaries scored the same or lower than it.