Combination therapy with fluconazole and flucytosine for pulmonary cryptococcosis.
We investigated, in vitro, the combined effects of fluconazole (FLCZ) and flucytosine (5-FC) against different strains of Cryptococcus neoformans, and retrospectively analyzed the clinical efficacy of combination therapy of FLCZ and 5-FC in patients with pulmonary cryptococcosis. The minimum inhibitory concentrations (MICs) of antifungal agents and drug interaction were determined by the broth microdilution method and checkerboard titration. FLCZ and 5-FC showed synergistic activity against 8 (32%) of 25 strains of C. neoformans. The clinical efficacy of the 2 drugs when combined together was good in 9 (90%) patients and fair in 1 (10%) patient with pulmonary cryptococcosis. Renal dysfunction occurred in 1 patient. Our results suggest that a combination therapy using FLCZ and 5-FC is clinically useful in patients with pulmonary cryptococcosis who otherwise show a limited response to monotherapy.
Yamamoto
Y
Y
Second Department of Internal Medicine, Nagasaki University School of Medicine, Japan.
Maesaki
S
S
Kakeya
H
H
Yanagihara
K
K
Ohno
H
H
Ogawa
K
K
Hirakata
Y
Y
Tomono
K
K
Tashiro
T
T
Kohno
S
S
D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage*; D003453:Cryptococcosis / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage*; D005437:Flucytosine / Q000008:administration & dosage*; D006801:Humans; D008172:Lung Diseases, Fungal / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged
D000935:Antifungal Agents; D015725:Fluconazole; D005437:Flucytosine