However, they are very expensive and some developing countries may not be able to use them. Ketoconazole It is not a good choice in the treatment of cryptococcosis, because it does not have a good CNS absorption. Still, its serum levels are decreased by concomitant use of riphampin and its derivatives, and carbamazepine, commonly used in these patients. Histamine blockers and antacids decrease its absorption. Fluconazole It has a good CNS penetration.
Side effects are mostly gastrointestinal.
There is a case relate of a patient that developed fulminant hepatitis with its use, though percipitated by previous amphotericin B usage. This work has recommended fluconazole dose adjustment or alternative fungal therapy in patients with renal impairment. It is a new approved drug that has a more pharmacologic properties like ketoconazole than fluconazole. Some hypothesize that yeasts would be responsible for CSF hypertension. Patients with symptomatic CSF hypertension should be spinal tapped serially when symptoms recover.