AMPHOTERICIN-B VERSUS AMPHOTERICIN-B PLUS 5-FLUCYTOSINE - POOR RESULTS IN THE TREATMENT OF PROVEN SYSTEMIC MYCOSES IN NEUTROPENIC PATIENTS

Twenty-eight neutropenic (< 500 granulocytes/mu l) adults with microbi ologically or histologically proven systemic mycosis were randomly ass igned to receive either amphotericin B alone (0.5 mg/kg/day; n = 14) o r amphotericin B (0.5 mg/kg/day) plus 5-flucytosine (150 mg/kg/day; n = 14) intravenously. Therapy was given for an average duration of 10 d ays in both groups, amounting to a total dose of amphotericin B of 338 mg and 308 mg, respectively. The mean duration of granulocytopenia wa s 18 days in the amphotericin B group and 20 days in the combination g roup. Only two patients treated with amphotericin B alone and three gi ven the combination survived. Adverse events were similiar in both gro ups with an elevation of the serum creatinine in six cases during the administration of amphotericin B alone and in seven cases treated with the combination. No other serious adverse events were encountered. Tr eatment with both regimens was disappointing partly because mycosis wa s too far advanced by the time therapy was begun and neutrophils were recovered in only half the patients.