Flucytosine and its clinical usage.
L Shamithra M Sigera1, David W Denning2
1Division of Infection, Immunity & Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK.
Therapeutic Advances in Infectious Disease
|April 13, 2023
Summary
Flucytosine is an antifungal with value in treating yeast infections, especially when combined with other antifungals. Improving global access to flucytosine can reduce mortality from invasive fungal diseases.
Area of Science:
- Mycology
- Pharmacology
- Infectious Diseases
Background:
- Flucytosine, an antifungal agent, has been available since the 1970s but its clinical use and global accessibility are limited.
- Despite its potential, clinical value has been overlooked, necessitating a review of its properties and applications.
Purpose of the Study:
- To review the clinical and pharmacological aspects of flucytosine.
- To focus on the clinical uses, efficacy, and resistance patterns of flucytosine in treating fungal infections.
Main Methods:
- A narrative review of clinical and in vitro susceptibility literature.
- Detailed literature review including historical data on primary and acquired resistance.
Main Results:
- Flucytosine exhibits antifungal activity against Cryptococcus, Candida, and dematiaceous fungi.
- Good penetration into CNS, eye, urinary tract, and biofilms due to water solubility.
- Combination therapy with amphotericin B improves survival in cryptococcal meningitis and reduces mortality in Candida meningitis.
- Monotherapy for urinary candidiasis is generally effective but associated with resistance.
- Not effective for aspergillosis or mucormycosis.
Conclusions:
- Flucytosine plays a crucial role in combination therapy for yeast and dematiaceous infections.
- It is likely valuable as monotherapy for urinary candidiasis, with a moderate risk of resistance.
- Enhancing global access to flucytosine, particularly in low-income countries, can decrease mortality from invasive fungal diseases.
Keywords:
Candida endophthalmitisCandida meningitisCandida speciesCandida urinary tract infectionCryptococcus speciesantifungal resistancecombination therapydematiaceous fungiflucytosinefungal endocarditisMore Related Videos
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