American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first-line treatment for nonmeningeal cryptococcosis?

1. Itraconazole

2. Fluconazole

3. Voriconazole

4. Flucytosine

The correct answer is: Fluconazole

Fluconazole is considered the first-line treatment for nonmeningeal cryptococcosis. This antifungal medication is effective due to its ability to inhibit fungal cell membrane synthesis through the blockade of ergosterol production, which is crucial for the integrity of fungal cell membranes. For nonmeningeal cryptococcosis, fluconazole is often the preferred choice because it has broad activity against Cryptococcus neoformans and boasts a favorable side effect profile as well as excellent bioavailability when administered orally. In many cases, treatment is initiated with fluconazole, especially when the disease is less severe and does not require the use of more aggressive therapies that are associated with higher toxicity. Other treatment options may be used in specific circumstances or may have indications in different clinical settings. Itraconazole, while effective against various fungal infections, is not typically the first choice for cryptococcosis. Voriconazole is also less commonly used for this particular infection, being more tailored towards other fungal pathogens. Flucytosine, while useful in certain cases, is generally reserved for combination therapy or more severe forms of the disease, particularly when there is central nervous system involvement. Thus, fluconazole is the most effective and appropriate choice as