{"id":30016,"date":"2026-05-30T04:20:00","date_gmt":"2026-05-29T20:20:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=30016"},"modified":"2026-05-30T07:06:58","modified_gmt":"2026-05-29T23:06:58","slug":"jama-netw-open%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%8d%95%e5%89%82%e8%84%82%e8%b4%a8%e4%bd%93%e4%b8%a4%e6%80%a7%e9%9c%89%e7%b4%a0%e8%81%94%e5%90%88%e6%b0%9f%e5%ba%b7%e5%94%91%e5%92%8c","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=30016","title":{"rendered":"[JAMA Netw Open\u53d1\u8868\u8bba\u6587]\uff1a\u5355\u5242\u8102\u8d28\u4f53\u4e24\u6027\u9709\u7d20\u8054\u5408\u6c1f\u5eb7\u5511\u548c\u6c1f\u80de\u5627\u5576\u6cbb\u7597\u9690\u7403\u83cc\u8111\u819c\u708e"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Infectious Diseases<\/p>\n\n\n\n

Single-Dose Liposomal Amphotericin Plus Fluconazole and Flucytosine for Cryptococcal Meningitis at a US Public Hospital<\/h1>\n\n\n\n

Devin Clark, Javier Barranco-Trabi, Irene Goo, et al<\/h3>\n\n\n\n

JAMA Netw Open 2026;9;(1):e2553552. doi:10.1001\/jamanetworkopen.2025.53552<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  What are the outcomes of the AMBITION protocol (single-dose liposomal amphotericin with 2 weeks of fluconazole and flucytosine) compared with guideline-compliant treatment for cryptococcal meningitis (CM) among patients with HIV in high-resource settings?<\/p>\n\n\n\n

Findings<\/strong>  In this cohort study of 60 patient episodes, the AMBITION protocol had similar mortality and CM recurrence rates compared with guideline-compliant treatment, with significantly fewer adverse events and less frequent patient-directed discharges.<\/p>\n\n\n\n

Meaning<\/strong>  The findings support broader adoption of the AMBITION protocol for CM in patients with HIV.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Cryptococcal meningitis (CM) is a significant cause of mortality and morbidity in people with HIV. Standard induction therapy for CM\u2014amphotericin with flucytosine\u2014is associated with significant toxic effects.<\/p>\n\n\n\n

Objective<\/strong>  To assess mortality and CM recurrence outcomes of the AMBITION protocol (single-dose liposomal amphotericin with 2 weeks of fluconazole and flucytosine) for treatment of CM in a high-resource setting.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This pre-post cohort study conducted at Los Angeles General Medical Center, a large safety net hospital (80% Medicaid-covered, 5% uninsured), included people with HIV treated for CM with the AMBITION protocol from August 1, 2022, to July 31, 2024, and a control population receiving a guideline-compliant, daily amphotericin-based regimen from August 1, 2020, to July 31, 2022. Exclusion criteria included age less than 18 years, alternative diagnosis, transfer during induction, and death within 48 hours of admission.<\/p>\n\n\n\n

Exposures<\/strong>  AMBITION protocol with single infusion of liposomal amphotericin (10 mg\/kg) and 14 days of high-dose fluconazole (1200 mg\/d) and flucytosine (100 mg\/kg\/d). The control group was treated with lipid-based amphotericin (3-5 mg\/kg\/d) and flucytosine (100 mg\/kg\/d) for 14 days.<\/p>\n\n\n\n

Main Outcome and Measures<\/strong>  The primary end point was treatment success, defined as a composite of survival without recurrence or severe adverse events at 90 days.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0A total of 60 eligible patient episodes were identified during the study period (54 [90.0%] among males; median patient age, 40 [IQR, 34-51] years). In all, 34 patients (56.7%) were treated with the AMBITION protocol, compared with 26 (43.3%) receiving the control regimen. Loss to follow-up by 90 days occurred in 6 patients in the control group (23.1%) and 9 intervention patients (26.5%) (P<\/em>\u2009=\u2009.76). Of patients with available data, the composite outcome occurred in 19 of 25 patients receiving the AMBITION protocol (76.0%) compared with 7 of 20 patients in the control group (35.0%) (P<\/em>\u2009=\u2009.006). The difference in composite outcome rates was driven by fewer severe adverse events in the AMBITION arm (7 [20.6%] vs 16 [61.5%];\u00a0P<\/em>\u2009=\u2009.001). Additionally, patients receiving the AMBITION protocol had fewer patient-directed discharges (4 [11.8%] vs 9 [34.6%];\u00a0P<\/em>\u2009=\u2009.03).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  In this pre-post study of HIV-associated CM, fewer severe adverse effects were seen in patients receiving the AMBITION protocol compared with a daily amphotericin-based regimen, with no difference in mortality or recurrence. There were also fewer patient-directed discharges, suggesting more patient-centered care. These findings support broader adoption of the AMBITION protocol in high-resource settings.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Infectious Diseases Single […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30016"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=30016"}],"version-history":[{"count":3,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30016\/revisions"}],"predecessor-version":[{"id":31035,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30016\/revisions\/31035"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=30016"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=30016"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=30016"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}