Absence of fungistatic antagonism between flucytosine and cytarabine in vitro and in vivo.

Determination of the MIC of flucytosine for 16 wild isolates of Cryptococcus neoformans and Candida spp. in YNBG medium containing 10 mg/l cytosine demonstrated antagonism of fungistatic activity compared with that determined in YNBG alone. Determination of the MIC in YNBG containing 10 mg/l cytarabine showed no change in activity for 14 of the strains, an increase for one and a decrease for another. Determination of serum flucytosine concentrations in a patient receiving cytarabine simultaneously revealed therapeutic levels. Fluctuations in serum flucytosine concentrations were observed in samples taken before, during and after concurrent cytarabine therapy but these may have resulted from unstable renal function rather than in-vivo inactivation of flucytosine by cytarabine. These data do not support significant antagonism of the fungistatic activity of flucytosine by cytarabine.

Assessment of oral candidiasis in patients with respiratory disease and efficacy of a new nystatin formulation.

Fifty consecutive patients with respiratory diseases who developed oropharyngeal candidiasis were assessed clinically and microbiologically before and after seven days' treatment with nystatin suspension or pastilles (a new formulation). In 45 patients in whom microbiology yielded positive results there was frequent associated use of oral corticosteroids, antibiotics, sedatives, and inhaled corticosteroid, while in a few patients atropine analogues may have predisposed to infection. Dentures were worn by 32 of the infected patients. Concomitant treatment of dentures in chronically infected patients appeared to improve the therapeutic response. Pastilles and suspension were equally efficacious both clinically and microbiologically. The potential for enhanced drug delivery to the oropharynx suggests that nystatin pastilles may be useful in patients in whom poor compliance seems likely.

Tobramycin and carbenicillin compared with gentamicin and carbenicillin in the treatment of infection with Pseudomonas aeruginosa in adult patients with cystic fibrosis.

Treatment with gentamicin or tobramycin given intravenously with carbenicillin is compared in the treatment of bronchopulmonary infection in older patients with cystic fibrosis. All patients improved on both regimens and there was no observed difference in the two treatments. Pseudomonas aeruginosa could still be isolated from the sputum 3 months after completion of treatment with both treatments. No toxic or allergic side-effects were noted.

Treatment of chronic mucocutaneous candidosis with ketoconazole: a study of 12 cases.

Twelve patients with chronic mucocutaneous candidosis were treated orally with ketoconazole (doses, 200-400 mg daily) for a mean period of six months. Seven of the patients had one of the following abnormalities: congenital endocrinopathy syndrome, an autosomal recessive or autosomal dominant defect in which candidosis is not associated with endocrinopathy, or the malabsorption syndrome. All patients had fungal infections of the mouth, and 11 had onychomycosis. Two patients were also infected with dermatophytes. At the end of treatment, 10 patients were cured of oral infection, and 11 with nail infections showed significant improvement. Marked improvement of hand and foot infections was also recorded. Patients infected with dermatophyte fungi had the poorest responses to therapy. The mean (+/- SD) MIC for isolates of Candida albicans from eight patients was 0.95 (+/- 0.78) microgram/ml. Clinical and biochemical monitoring showed no toxicity, and no resistant fungi emerged during treatment. Results of this initial study of ketoconazole for treatment of severe and recalcitrant superficial infections indicate the need for further assessment of this drug, which appears to offer a simple, nontoxic, and effective treatment of fungal infections.