Chapter 14 : Therapy of Cryptococcosis

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Therapy of Cryptococcosis, Page 1 of 2

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The hypothesis that estrogen therapy might be useful in treatment was based on the observation that in both humans and animals, males appear to be more susceptible to cryptococcosis than females. Infact, Mohr et al. performed two insightful studies on sex hormones. These studies showed that patients with cryptococcal meningitis who were given doses of the estrogenic hormone diethylstilbestrol increased their host-cell phagocytic capacities. This work, like serotherapy, was one of the first studies on immune modulation for treatment of cryptococcosis. Shadomy et al. examined 77 strains against amphotericin B, hamycin, and flucytosine, using a broth dilution technique, and found that all strains were very susceptible to amphotericin B at MICs of <0.2 μg/ml. In this work, the importance of media for these antifungal tests was first recognized. With the combination of more antifungal agents and the concern about antifungal drug resistance, there was a renewed focus on antifungal drug susceptibility testing. Flucytosine has been very successfully combined with amphotericin B to take advantage of their synergistic or additive mechanisms of actions and their different but complementary pharmacokinetics. First, this combination has reduced concerns about the development of drug-resistant strains and, in fact, flucytosine resistance has not generally been reported during combination therapy. Second, the combination therapy has allowed a reduction in the amount of amphotericin B needed to treat cryptococcosis, and this helps to limit its known toxicity.

Citation: Casadevall A, Perfect J. 1998. Therapy of Cryptococcosis, p 457-518. In . ASM Press, Washington, DC. doi: 10.1128/9781555818241.ch14

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