Trial reportAntimicrobial agents and chemotherapy2007
Oral versus intravenous flucytosine in patients with human immunodeficiency virus-associated cryptococcal meningitis.
Trial report in Antimicrobial agents and chemotherapy, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
27 citing papers in PubMed, 1 synthesis or guideline pooled it, 59 citations in OpenAlex.
- Treatment for HIV-associated cryptococcal meningitis.The Cochrane database of systematic reviews · 2018Pooled it
- Toxicity of Amphotericin B Deoxycholate-Based Induction Therapy in Patients with HIV-Associated Cryptococcal Meningitis.Antimicrobial agents and chemotherapy · 2015Trial
- A phase II randomized controlled trial adding oral flucytosine to high-dose fluconazole, with short-course amphotericin B, for cryptococcal meningitis.AIDS (London, England) · 2012Trial
- Clinical pharmacokinetics of oral controlled-release 5-fluorocytosine.Antimicrobial agents and chemotherapy · 2010Trial
- Combination flucytosine and high-dose fluconazole compared with fluconazole monotherapy for the treatment of cryptococcal meningitis: a randomized trial in Malawi.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2010Trial
- Assessing Statistical Methods for Estimating the Cerebrospinal Fluid Early Fungicidal Activity as an Endpoint for Cryptococcal Meningitis Clinical Trials: A Systematic Review and Simulation Study.Open forum infectious diseases · 2026Article
- A Novel and Robust Method for Investigating Fungal Biofilm.Bio-protocol · 2025Article
- 5-Flucytosine Longitudinal Antifungal Susceptibility Testing ofOpen forum infectious diseases · 2023Article
- Population pharmacokinetics and CSF penetration of flucytosine in adults with HIV-associated cryptococcal meningoencephalitis.The Journal of antimicrobial chemotherapy · 2023Article
- Therapeutic Drug Monitoring of Antifungal Agents in Critically Ill Patients: Is There a Need for Dose Optimisation?Antibiotics (Basel, Switzerland) · 2022Review
- Molecular Mechanisms of 5-Fluorocytosine Resistance in Yeasts and Filamentous Fungi.Journal of fungi (Basel, Switzerland) · 2021Review
- Cryptococcal meningitis: a review for emergency clinicians.Internal and emergency medicine · 2021Review
- Feasibility of intracerebrally administering multiple doses of genetically modified neural stem cells to locally produce chemotherapy in glioma patients.Cancer gene therapy · 2021Article
- Drug Resistance and Novel Therapeutic Approaches in Invasive Candidiasis.Frontiers in cellular and infection microbiology · 2021Review
- Southern African HIV Clinicians Society guideline for the prevention, diagnosis and management of cryptococcal disease among HIV-infected persons: 2019 update.Southern African journal of HIV medicine · 2019Article
- Pre-Existing Liver Disease and Toxicity of Antifungals.Journal of fungi (Basel, Switzerland) · 2018Review
- Neural Stem Cell-Based Anticancer Gene Therapy: A First-in-Human Study in Recurrent High-Grade Glioma Patients.Clinical cancer research : an official journal of the American Association for Cancer Research · 2017Article
- Antifungal Efficacy of an Intravenous Formulation Containing Monomeric Amphotericin B, 5-Fluorocytosine, and Saline for Sodium Supplementation.Pharmaceutical research · 2017Article
- Cryptococcal meningitis: epidemiology, immunology, diagnosis and therapy.Nature reviews. Neurology · 2017Review
- Comparative effectiveness of induction therapy for human immunodeficiency virus-associated cryptococcal meningitis: a network meta-analysis.Open forum infectious diseases · 2015Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 5 institutions in 3 countries.
Funding
Abstract
In a randomized controlled trial of amphotericin B-based therapy for human immunodeficiency virus (HIV)-associated cryptococcal meningitis in Thailand, we also compared the mycological efficacy, toxicity, and pharmacokinetics of oral versus intravenous flucytosine at 100 mg/kg of body weight/day for the initial 2 weeks. Half of 32 patients assigned to the two arms containing flucytosine were randomized to oral and half to intravenous flucytosine. Early fungicidal activity was determined from serial quantitative cultures of cerebrospinal fluid (CSF), and toxicity was assessed by clinical and laboratory monitoring. Flucytosine and fluorouracil concentrations in plasma and CSF were measured by high-performance liquid chromatography. No significant bone marrow or hepatotoxicity was seen, there was no detectable difference in bone marrow toxicity between patients on intravenous and those on oral formulation, and no patients discontinued treatment. In patients receiving intravenous flucytosine, the median 24-h area under the concentration-time curve was significantly higher than in the oral group. Despite this difference, there was no difference in early fungicidal activity between patients on intravenous compared with patients on oral flucytosine. The results suggest that either formulation can be used safely at this dosage in a developing country setting, without drug concentration monitoring. The bioavailability of the oral formulation may be reduced in late-stage HIV-infected patients in Thailand. Concentrations of flucytosine with intravenous formulation at 100 mg/kg/day may be in excess of those required for maximal fungicidal activity.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.