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Flucytosine and its clinical usage. | LitMetric

Flucytosine and its clinical usage.

Ther Adv Infect Dis

Division of Infection, Immunity & Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.

Published: April 2023

AI Article Synopsis

  • Flucytosine is an antifungal agent from the 1970s that remains underused and less available worldwide, despite its significant clinical benefits and pharmacological properties.
  • The drug is effective against various fungal infections, particularly in combination with amphotericin B, enhancing survival rates in conditions like cryptococcal meningitis and showing promise for neonatal candidiasis.
  • Resistance to flucytosine can develop during treatment, especially for urinary candidiasis, and improving access to this medication in underserved regions could reduce mortality rates from serious fungal infections.

Article Abstract

Flucytosine is an antifungal agent first licensed in the 1970's. However, its clinical value has long been overlooked and its availability across the globe is limited. This review highlights the important clinical and pharmacological aspects of flucytosine. This a narrative review of the clinical and susceptibility literature, with a focus on clinical uses for flucytosine. Detailed literature review including early literature related to primary and acquired resistance to flucytosine. Flucytosine has good antifungal activity against species, species, and dematiaceous fungi. Its water solubility enables good penetration into the eye, urinary tract, central nervous system (CNS), cardiac vegetations and fungal biofilms. In combination with amphotericin B, it shows early fungicidal activity against species, and this translates to ~20% improved survival in cryptococcal meningitis. Combination therapy also reduces the mortality of meningitis, and should be used in neonatal candidiasis because of the high frequency of CNS infection. Monotherapy for urinary candidiasis is under-studied, but is usually effective. It is probably valuable in the treatment of endocarditis and endophthalmitis: there are few data. It is not effective for aspergillosis or mucormycosis. Flucytosine monotherapy of urinary candidiasis resulted in 22% developing resistance on therapy and failing therapy, and in 29% of 21 patients with cryptococcosis. Certain regions of the world still do not have access to flucytosine compromising the management of certain severe fungal infections. Flucytosine has an important role in combination therapy for yeast and dematiaceous infections and probably as monotherapy for urinary candidiasis, with a modest risk of resistance emergence. Facilitating access to flucytosine in those regions (especially low-income countries) might alleviate the mortality of invasive fungal diseases.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10084540PMC
http://dx.doi.org/10.1177/20499361231161387DOI Listing

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