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Combo Therapy Helps Knock Out Fungal Meningitis
Date:4/3/2013

By Serena Gordon
HealthDay Reporter

WEDNESDAY, April 3 (HealthDay News) -- A drug regimen containing two powerful antifungal medicines -- amphotericin B and flucytosine -- reduced the risk of dying from cryptococcal meningitis by 40 percent compared to treatment with amphotericin B alone, according to new research.

The study also found that those who survived the illness were less likely to be disabled if they received treatment that included flucytosine.

"Combination antifungal therapy with amphotericin and flucytosine for HIV-associated cryptococcal meningitis significantly reduces the risk of dying from this disease," said the study's lead author, Dr. Jeremy Day, head of the CNS-HIV Infections Group for the Wellcome Trust Major Overseas Program in Vietnam.

"This combination could save 250,000 deaths across Africa and Asia each year. The key to achieving this will be improving access to the antifungal agent flucytosine," said Day, also a research lecturer at the University of Oxford.

Flucytosine is more than 50 years old and off patent, according to Day. The drug has few manufacturers, and it isn't licensed for use in many of the countries where the burden from this disease is highest, he said. Where it is available, the limited supply often drives the cost higher, Day noted.

"We hope the results of this study will help drive increased and affordable access to both amphotericin and flucytosine," he said.

Infectious disease specialist Dr. Bruce Hirsch, an attending physician at North Shore University Hospital in Manhasset, N.Y., said that in the United States, "the use of these medicines, amphotericin and flucytosine, is the usual standard of care for this dangerous infection, and is followed by long-term treatment with fluconazole [another antifungal]."

But, Hirsch noted that this infection is unusual to see in the United States.

That's definitely not the case in the rest
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