ArticleMycoses2019
The combination of tamoxifen with amphotericin B, but not with fluconazole, has synergistic activity against the majority of clinical isolates of Cryptococcus neoformans.
Article in Mycoses, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
What it found
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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.
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Who cites it
19 citing papers in PubMed, 32 citations in OpenAlex.
- Trial
- A review of the current anti-New microbes and new infections · 2026Review
- Article
- Clinical treatment of cryptococcal meningitis: an evidence-based review on the emerging clinical data.Journal of neurology · 2024Review
- Old and new strategies in therapy and diagnosis against fungal infections.Applied microbiology and biotechnology · 2024Review
- Searching for new antifungals for the treatment of cryptococcosis.Revista da Sociedade Brasileira de Medicina Tropical · 2023Review
- Genomic Approaches to Antifungal Drug Target Identification and Validation.Annual review of microbiology · 2022Review
- Review
- Tamoxifen Twists Again: On and Off-Targets in Macrophages and Infections.Frontiers in pharmacology · 2022Review
- Problems associated with the use of the term "antibiotics".Naunyn-Schmiedeberg's archives of pharmacology · 2021Review
- Docusate-Based Ionic Liquids of Anthelmintic Benzimidazoles Show Improved Pharmaceutical Processability, Lipid Solubility, andACS infectious diseases · 2021Article
- Delivery strategies of amphotericin B for invasive fungal infections.Acta pharmaceutica Sinica. B · 2021Review
- Drug repurposing strategies in the development of potential antifungal agents.Applied microbiology and biotechnology · 2021Review
- Small-molecule inhibitors for the Prp8 intein as antifungal agents.Proceedings of the National Academy of Sciences of the United States of America · 2021Article
- Antifungal Drug Repurposing.Antibiotics (Basel, Switzerland) · 2020Article
- Screening Repurposing Libraries for Identification of Drugs with Novel Antifungal Activity.Antimicrobial agents and chemotherapy · 2020Review
- New Approaches for Cryptococcosis Treatment.Microorganisms · 2020Review
- Article
- Diagnosis and Management of Central Nervous System Cryptococcal Infections in HIV-Infected Adults.Journal of fungi (Basel, Switzerland) · 2019Review
Corrections and comments
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Authors and funding
9 authors at 5 institutions in 3 countries.
Funding
Abstract
backgroundCryptococcal meningitis has fatality rates of 40%-70%, resulting in 200 000 deaths each year. The best outcomes are achieved with amphotericin combined with flucytosine but flucytosine is expensive and unavailable where most disease occurs. More effective and affordable treatments are needed. Tamoxifen, a selective oestrogen receptor modulator frequently indicated for breast cancer, has been found to have synergistic activity against the Cryptococcus neoformans type strain when combined with amphotericin or fluconazole. It is cheap, off-licence, widely available and well-tolerated, and thus a pragmatic potential treatment for cryptococcal disease.
objectivesWe wanted to determine the susceptibility of clinical isolates of C. neoformans to tamoxifen alone and in combination with other antifungals, to determine whether there is sufficient evidence of activity to justify a clinical trial.
methodsWe used the CLSI broth microdilution protocol to test the susceptibility of 30 randomly selected clinical isolates of C. neoformans to tamoxifen, in dual combination with amphotericin, fluconazole or flucytosine, and in triple combination with amphotericin and fluconazole. Evidence of drug interactions was assessed using the fractional inhibitory concentration index.
resultsThe MIC50 and MIC90 of tamoxifen were 4 and 16 mg/L, respectively. The combination of tamoxifen and amphotericin suggested a synergistic interaction in 20 of 30 (67%) isolates. There was no interaction between tamoxifen and either fluconazole or flucytosine. Synergy was maintained in 3-Dimensional chequerboard testing. There was no evidence of antagonism.
conclusionsTamoxifen may be a useful addition to treatment with amphotericin and fluconazole for cryptococcal meningitis; a trial is justified.
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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.