5-FLUOROCYTOSINE IN THE TREATMENT OF CRYPTOCOCCAL MENINGITIS

Abstract

A patient with cryptococcal meningtis was treated with continuous ventricular drainage, amphotericin B and 5-fluorocytosine (5-FC). Cryptococcus neoformans disappeared and apparent cure was achieved. In the course of therapy, withdrawal of 5-FC aggravated the CSF findings in spite of continuous ' administration of amphotericin B, but re-administration of the drug yielded rapid improvement.
Determination of minimal inhibitory concentrations of 5°FC for Cryptococcus neoformans cultured from patient's cerebrospinal fluid indicated 12. 5 μg/ml repeatedly.
Serum and cerebrospinal concentrations of 5-FC were as follows : 62 to 100μg/ml, 32 to 40μg/ml, respectively with a dosage of 10 g/day;50 to 79μg/ml, 25μg/ml, 7g/day; 10 to 50μg/ml, 10 to 17.5 μg/ml, 5g/day.
Significant evidence of toxicity was not observed.