Combined treatment with amphotericin B and flucytosine in severe fungal infections

Four cases of severe, deep seated fungal infections were treated with a combination of flucytosine (5-fluorocytosine, 5-FC) and amphotericin B (AmB). One of the patients had a Candida endophthalmitis, one an endophthalmitis which had deteriorated during steroid treatment and which healed during antimycotic treatment, one an endocarditis caused by a 5-FC-resistant strain of Torulopsis glabrata and one a Candidasepticemia that did not respond to treatment with 5-FC alone. In all patients the combined treatment with 5-FC and AmB was successful and no severe side effects were observed. The possible mechanisms of synergism between 5-FC and AmB are discussed and the existence of such a synergism in vivo was strongly suggested by the successful outcome in the case of 5-FC-resistant Torulopsis septicemia.