Skip to main content
SpringerLink
Log in

Combination therapy for systemic mycosis

  • Review
  • Published:
Infection Aims and scope Submit manuscript

Conclusion

The use of antifungals in combination can clearly improve efficacy, broaden spectrum and reduce the duration of therapy. The availability of more systemic antifungals may lead to an increase in the use of triple combinations, especially against fungal infection in immunosuppressed patients. 5-flucytosine plus amphotericin B is still the most active combination with proven clinical application in cryptococcosis and candidosis. Combinations of 5-flucytosine with ketoconazole or itraconazole have shown promising results and may well play a role in human chemotherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Polak, A. Combined therapy of systemic mycoses. Proc. 13th Intern. Congr. Chemother. Vienna 1983. Spitzy, K. H., Karrer, K. (eds.). Symposia 49/1 and 49/2, part 20, H. Egermann, Vienna, pp. 2–9.

    Google Scholar 

  2. Polak, A. Combination therapy with antifungal drugs. Mycoses 31 (Suppl. 2) (1988) 45–53.

    Google Scholar 

  3. Polak, A., Schaffner, A. Association des antifongiques dans les mycoses expérimentales. Méd. Mal. Inf. 14 (11) (1984) 553–557.

    Google Scholar 

  4. Polak, A. Combination therapy of experimental candidiasis, cryptococcosis, aspergillosis and wangiellosis in mice. Chemotherapy 33 (1987) 381–395.

    Google Scholar 

  5. Polak, A., Scholer, H. J., Wall, M. Combination therapy of experimental candidiasis, cryptococcosis and aspergillosis in mice. Chemotherapy 28 (1982) 461–479.

    Google Scholar 

  6. Polak, A. 5-Fluorocytosine et associations. Ann. Biol. Clin. 45 (1987) 669–671.

    Google Scholar 

  7. Thaler, M., Bacher, J., O'Leary, T. Evaluation of single-drug and combination antifungal therapy in an experimental model of candidiasis in rabbits with prolonged neutropenia. J. Inf. Dis. 158 (1) (1988) 80–88.

    Google Scholar 

  8. Hughes, C. E., Peterson, L. R., Beggs, W. H., Gerding, D. N. Ketoconazole and flucytosine alone and in combination againstCandida spp. in a neutropenic site in rabbits. J. Antimicrob. Chemother. 18 (1986) 65–72.

    Google Scholar 

  9. Schaffner, A., Frick, P. G. The effect of ketoconazole on amphotericin B in a model of disseminated aspergillosis. J. Inf. Dis. 151 (5) (1985) 902–920.

    Google Scholar 

  10. Bennett, J. E., Dismukes, W. E., Duma, R. J., Medoff, G., Sande, M. A., Gallis, H., Leonard, J., Fields, B. T., Bradshaw, M., Haywood, H., McGee, Y. A., Cate, Th. R., Cobbs, C. G., Warner, J. F., Alling, D. W. A comparison of amphotericin B alone and combined with flucytosine in the treatment of cryptococcal meningitis. New Engl. J. Med. 301 (3) (1979) 127–131.

    Google Scholar 

  11. Dismukes, W. E., Cloud, G., Gallis, H. A., Kerkering, T. M., Medoff, G., Craven, P. C., Kaplowitz, L. G., Fisher, J. F., Gregg, C. R., Bowles, C. A., Shadomy, S., Stamm, A. M., Diasio, R. B., Kaufman, L., Soong, S-J., Blackwelder, W. C. Treatment of cryptococcal meningitis with combination amphotericin B and flucytosine for four as compared with six weeks. New Engl. J. Med. 317 (6) (1987) 334–341.

    Google Scholar 

  12. Kauffmann, C. A., Frame, P. T. Bone marrow toxicity associated with 5-fluorocytosine therapy. Antimicrob. Agents Chemother. 11 (2) (1977) 244–247.

    Google Scholar 

  13. Heidemann, H., Krich, W., Gerkens, J., Branch, R. Salzbeladung verringert Amphotericin B-induzierte Nephrotoxizität. Verh. Ges. inn. Med. 89 (1983) 921–922.

    Google Scholar 

  14. Heidemann, H., Jacqz, E., Ohnhaus, E., Ray, W., Branch, R.: The importance of Na loading on amphotericin B nephrotoxicity considering the combination with 5-fluorocytosine and ticarcillin. Recent Advances in Chemotherapy. Antimicr. Section 3 (Proc. 14th Int. Congr. Chemother. Kyoto 1985) 2628–2629.

  15. Chernoff, D. N., Sande, M. A.: Cryptococcal infections in patients with the Acquired Immunodeficiency Syndrome (AIDS). Paper presented at the Conférence Internationale sur le SIDA, 23–25 June, 1986, Paris, Abstr. No. 543.

  16. Staib, F., Roegler, G., Pruefer-Kraemer, L., Seibold, M., Eichenlaub, D., Pohle, H. D. Disseminierte Kryptokokkose bei zwei AIDS-Patienten. Dtsch. Med. Wochenschr. 111 (1986) 1061–1065.

    Google Scholar 

  17. Staib, F. Kryptokokkose bei AIDS aus mykologisch-diagnostischer und epidemiologischer Sicht. AIDS-Forschung 2 (1987) 363–382.

    Google Scholar 

  18. Sugar, A. M., Saunder, D. Oral fluconazole as suppressive therapy of disseminated cryptococcosis in patients with Acquired Immunodeficiency Syndrome. Am. J. Med. 85 (1988) 481–489.

    Google Scholar 

  19. Viviani, M. A., Tortorano, A. M.: Management of cryptococcosis in AIDS patients. 10th Congr. Int. Soc. Human Animal Mycology ISHAM, Barcelona, 27 June–1 July 1988 (poster presentation).

  20. Viviani, M. A., Tortorano, A. M., Woenstenborghs, R., Cauwenbergh, G. Experience with itraconazole in deep mycoses in northern Italy. Mykosen 30 (1988) 233–244.

    Google Scholar 

  21. Baley, J. E., Kliegman, R. M., Fanaroff, A. A. Disseminated fungal infections in very low birth-weight infants: therapeutic toxicity. Pediatrics 73 (2) (1984) 153–157.

    Google Scholar 

  22. Burnie, J. P., Matthews, R., Lee, W., Philpott-Howard, J., Brown, R., Damani, N., Breuer, J., Honeywell, K., Jordans, Z. Four outbreaks of nosocomial systemic candidiasis. Epidem. Inf. 99 (1987) 201–211.

    Google Scholar 

  23. Armstrong, D.: Problems in the management of opportunistic fungal infections. 9th Ian Murray Memorial Lecture. Brit. Soc. Mycopathol. 1986.

  24. v. Eiff, M., Essink, M., Roos, N., Hiddemann, W., Buechner, Th., van de Loo, J.: Hepatosplenic candidosis. Zeitschr. Antimikrob. Antineoplast. Chemother. (1989) (Suppl. 1, pp. 1).

  25. Haron, E., Feld, R., Tuffnell, P., Patterson, B., Hasselback, R., Matlow, A. Hepatic candidiasis: an increasing problem in immunocompromised patients. Am. J. Med. 83 (1987) 17–26.

    Google Scholar 

  26. Dupont, B., Drouhet, E. Cutaneous, ocular, and osteoarticular candidiasis in heroin addicts: new clinical and therapeutic aspects in 38 patients. J. Inf. Dis. 152 (1985) 577–591.

    Google Scholar 

  27. Oelz, O., Marugg, D., Morell, B., Schaer, G., Martenet, A. C.: Successful treatment of Candida endophthalmitis by intravenous amphotericin B and flucytosine. In:Ishigami, J. (ed.): Recent Advances in Chemotherapy. Antimicrobial Section 3 (Proc. of the 14th Int. Congr. of Chemother., Kyoto), 1985, pp. 2531–2532.

  28. Slingeneyer, A., Laroche, B., Stec, F., Canaud, B., Beraud, J. J., Mion, C.: Oral ketoconazole (Ktz) plus intraperitoneal 5-fluorocytosine (5-FI) as the sole treatment of fungal peritonitis (FP) in CAPD. (Personal communication).

  29. Burkert, M., Fuhr, H. G., Mertelsmann, R.: Antimycotic combination therapy in patients with acute myeloblastic leukemia. 6th Med. Congr. Chemother., Taormina, 22–27 May 1988, pp. 108 (Abstr. No. 81).

  30. Borelli, D.: A clinical trial of itraconazole in the treatment of deep mycoses and leishmaniasis. Rev. Inf. Dis. 9 (1987) Suppl. 1 S57.

  31. Atukorala, D. N., Pothupitiya, G. M. Treatment of chromomycosis with a combination of ketoconazole and 5-fluorocytosine. Cezlon Med. J. 30 (4) (1985) 193–195.

    Google Scholar 

  32. Wolf, H. H., Scharf, R. R., Arning, M., Schneider, W.: Itraconazole treatment in patients with systemic fungal infections. Zeitschr. Antimikrob. Antineoplast. Chemother. (1989) (Suppl. 1), 1 (Abstract 75).

Download references

Author information

Authors and Affiliations

  1. F. Hoffmann-La Roche Ltd, CH-4002, Basel

    Annemarie Polak

Authors
  1. Annemarie Polak
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Polak, A. Combination therapy for systemic mycosis. Infection 17, 203–209 (1989). https://doi.org/10.1007/BF01639520

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01639520

Keywords

Search

Navigation