Combined therapy with amphotericin B and 5-fluorocytosine for Candida meningitis

The course and outcome of combined treatment with amphotericin B and 5-fluorocytosine were analyzed in 17 patients with candida meningitis. Eleven patients were twelve months of age or younger; seven of these were neonates. All but two patients had underlying conditions or therapy that could predispose them to systemic candidiasis. The median duration of concurrent dual therapy was 26 days; in ten cases, therapy with either drug alone was continued longer. Fifteen patients improved; 14 were cured of their infection. Cultures of cerebrospinal fluid became sterile a median of seven days after the start of therapy. Primary resistance to 5-fluorocytosine was found in four of the Candida isolates, and acquired resistance, in one. Serious adverse drug reactions were uncommon. The two patients who died had received intrathecal rather than systemic amphotericin B. One of eight infants who survived had psychomotor retardation; three of eleven infants developed hydrocephalus. Although experience with candida meningitis is limited, the combination of amphotericin B and 5-fluorocytosine is effective and offers potential advantages over amphotericin B alone.