[The activity of systemic antimycotic drug combinations]

The treatment of deep mycoses is complex, especially in immunosuppressive patients, owing to several factors: the scarcity of antimycotic drugs, the difficulty of carrying out antimycotic susceptibility tests, the scarcity of in vitro/in vivo correlation studies, the lesser response to therapy in comparison to antibacterial treatment, etc. Aside from this, the adverse effects, therapeutic failure and the appearance of resistance are serious problems that may emerge with the use of antimycotic drugs. These problems can be partly avoided by using combinations of antimycotics. In this article, the results obtained by different authors when using systemic antimycotics in combined therapy are reviewed. The effect of the combination of amphotericin B and azoles varies according to the moment of administration: when the azole is administered before amphotericin B, antagonism between the two has been observed; however, when they are administered simultaneously the effect is synergistic with the hydrophylic azoles (fluconazole), antagonistic with lipophilic azoles (itraconazole) or indifferent. The combination of flucytosine with azoles has been demonstrated to be synergistic on Candida albicans (itraconazole, fluconazole) and on Cryptococcus neoformans (fluconazole). With the combinations of an equinocandine and amphotericin B or fluconazole, synergism has been observed on C. neoformans.