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Flucytosine monotherapy for cryptococcosis

D R Hospenthal1, J E Bennett

  • 1Clinical Mycology Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|August 26, 1998
PubMed
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Flucytosine (5-FC) monotherapy for cryptococcosis is not recommended due to emerging drug resistance. This study found a 57% failure rate, though the treatment was well-tolerated.

Area of Science:

  • Infectious Diseases
  • Medical Mycology
  • Pharmacology

Background:

  • Flucytosine (5-FC) monotherapy is generally not recommended for cryptococcosis due to the high risk of developing drug resistance.
  • Empirical evidence supporting this widely accepted clinical practice is limited.

Purpose of the Study:

  • To review the efficacy and outcomes of flucytosine monotherapy in cryptococcosis patients treated between 1968 and 1973.
  • To assess the development of flucytosine resistance during monotherapy in a select patient group.

Main Methods:

  • Retrospective review of 27 patients treated with flucytosine monotherapy.
  • Patient selection based on criteria predictive of a good prognosis.
  • Analysis of treatment response, failure rates, and development of drug resistance.

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Main Results:

  • Overall response (cure or improvement) was observed in 10 (43%) of 23 evaluable patients.
  • Therapy failure occurred in 13 patients (57%), with resistance developing in 6 (50%) of those who failed.
  • Flucytosine monotherapy was generally well-tolerated.

Conclusions:

  • The high failure rate (57%) confirms that flucytosine monotherapy is not suitable for cryptococcosis treatment.
  • Despite the failure rate, flucytosine was well-tolerated, and resistance did not always develop.
  • Further research into combination therapies is warranted to improve outcomes in cryptococcosis.