American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the long-term treatment interval for oral fluconazole in cryptococcal meningitis maintenance therapy in AIDS patients?

1. 4 weeks

2. 8 weeks

3. ≥1 year

4. 6 months

The correct answer is: ≥1 year

In the context of maintaining treatment for cryptococcal meningitis in patients with AIDS, the correct long-term treatment interval for oral fluconazole is a minimum of one year. This duration is essential because cryptococcal meningitis is a serious fungal infection that can recur in immunocompromised individuals, such as those with AIDS. Following the initial treatment phase, which typically consists of intensive therapy to control the infection, maintenance therapy with fluconazole is necessary to reduce the risk of relapse. The recommendation for at least one year of maintenance therapy is based on clinical studies that show this duration significantly decreases the chance of recurrence of the infection. For patients who are at a higher risk, such as those with ongoing immunosuppression, continuing fluconazole beyond one year may be considered based on clinical judgment. Other potential treatment intervals listed are not sufficient for the long-term prevention of relapse in cryptococcal meningitis. Shorter durations, like 4 weeks, 6 months, or even 8 weeks, do not provide the long-term protection needed in these immunocompromised patients, thus underscoring the importance of the one-year maintenance strategy in the management of this condition.