Monitoring
Careful monitoring of serum electrolytes, renal function, and bone marrow function is essential in order to recognise and treat antifungal drug toxicity.[20]
In HIV-negative patients, the duration of therapy is based on disease resolution, but it is usually 6 to 18 months.[58] There is a high risk of relapse among patients with cryptococcal meningitis who are not receiving adequate maintenance therapy. Maintenance therapy may be discontinued in HIV-positive patients who respond to antiretroviral treatment (ART; i.e., CD4 cell counts ≥100 cells/mm³, undetectable viral loads on ART, minimum of 1 year of azole antifungal chronic maintenance therapy after successful treatment of cryptococcosis).[20] It should be reinitiated if the CD4 count decreases to <100 cells/mm³.[20]
Immune reconstitution inflammatory syndrome should be considered when worsening of the clinical status occurs despite adequate treatment.[20]
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