Recent Developments in the Therapy of Chromoblastomycosis1

There was no specific treatment for chromoblastomycosis until 5-fluorocytosine became available. A number of different drugs and therapeutic procedures were used for this mycosis, but none had proved absolutely effective. The first cases of successful treatment of chromoblastomycosis using 5-fluorocytosine, substantiated by monitored results, were reported by Lopes and colleagues (10, 11, 12, 13, 15). Flucytosine (5-fluorocytosine, or 5-FC) is a fluorinated pyrimidine that actively combats the following fungi: Candida albicans, Gyptococcus neoforrnans, and the agents causing chromoblastomycosis. The way it acts on these fungi is not yet clearly understood. Contact with the fungus produces deamination of the drug, and its deaminated form-known as 5-fluorouracil-apparently inhibits protein synthesis in the parasite (21-24). Cryptococcosis, systemic candidiasis, and chromoblastomycosis have been successfully treated with 5-FC. It is produced in the form of 500-mg tablets for oral administration, and the recommended dosage ranges from 100 to 200 mglkg of body weight daily, divided into 4 doses. Over 98 per cent of the drug is excreted virtually intact in the urine; thus it is not metabolized or retained by the body (24). Perfect renal function is therefore required. In