In patients with AIDS, what is used for prophylaxis against Cryptococcus neoformans?

In patients with AIDS, fluconazole is the preferred agent for prophylaxis against Cryptococcus neoformans. This fungus is a significant cause of opportunistic infections in immunocompromised individuals, particularly those with advanced HIV infection or AIDS.

Fluconazole demonstrates good efficacy in preventing cryptococcal infections, specifically in patients with a CD4 count less than 100 cells/mm³, where the risk of developing cryptococcal meningitis is notably increased. It works by inhibiting the synthesis of ergosterol, an essential component of fungal cell membranes, thereby exerting antifungal activity.

While amphotericin B is a potent antifungal used to treat severe fungal infections, including cryptococcal meningitis, it is not typically used for prophylaxis due to its toxicity and side effects, making it less suitable as a preventive measure. Voriconazole and ketoconazole are antifungals that are not recommended for cryptococcal prophylaxis either; voriconazole is primarily used for treating Aspergillus and certain other fungal infections, and ketoconazole is less commonly used due to its side effect profile and has largely been replaced by newer agents with better safety and efficacy profiles.

Therefore, fluconazole stands out as the ideal choice