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Flucytosine and cryptococcosis: time to urgently address the worldwide accessibility of a 50-year-old antifungal.

Loyse, A; Dromer, F; Day, J; Lortholary, O; Harrison, TS (2013) Flucytosine and cryptococcosis: time to urgently address the worldwide accessibility of a 50-year-old antifungal. J Antimicrob Chemother, 68 (11). pp. 2435-2444. ISSN 0305-7453 https://doi.org/10.1093/jac/dkt221
SGUL Authors: Harrison, Thomas Stephen Loyse, Angela

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Abstract

Current, widely accepted guidelines for the management of HIV-associated cryptococcal meningoencephalitis (CM) recommend amphotericin B combined with flucytosine (5-FC) for ≥2 weeks as the initial induction treatment of choice. However, access to flucytosine in Africa and Asia, where disease burden is greatest, is inadequate at present. While research into identifying effective and well-tolerated antifungal combinations that do not contain flucytosine continues, an ever-increasing body of evidence from in vitro, in vivo and clinical studies points to the benefits of flucytosine in the treatment of CM in both intravenous combinations with amphotericin B and oral combinations with high-dose fluconazole. This article provides an up-to-date review of this evidence, and the current issues and challenges regarding increasing access to this key component of combination antifungal therapy for cryptococcosis.

Item Type: Article
Keywords: 5-FC, 5-FC safety, access to essential antifungals for cryptococcal meningitis, combination antifungal therapy, cryptococcal meningitis, cryptococcal meningitis treatment guidelines, opportunistic infection
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: J Antimicrob Chemother
ISSN: 0305-7453
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Dates:
DateEvent
20 June 2013Published
PubMed ID: 23788479
Web of Science ID: 23788479
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URI: http://sgultest.da.ulcc.ac.uk/id/eprint/102919
Publisher's version: https://doi.org/10.1093/jac/dkt221

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