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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
PubMed
Summary
This summary is machine-generated.

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.

Keywords:
Candida endophthalmitisCandida meningitisCandida speciesCandida urinary tract infectionCryptococcus speciesantifungal resistancecombination therapydematiaceous fungiflucytosinefungal endocarditis

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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.