Treatment of Candida arthritis with flucytosine and amphotericin B.

Abstract

A premature infant with disseminated Candida tropicalis infection with arthritis and osteomyelitis is presented. Although the organism was susceptible to amphotericin B, synovial fluid cultures were still positive for yeast after 2 weeks of intravenous amphotericin B therapy. The addition of oral flucytosine (25 mg/kg four times daily) resulted in sterilization of the synovial fluid within 4 days. Simultaneous serum and synovial levels of flucytosine were 47.5 micrograms/ml and 39.6 micrograms/ml, respectively. This is the first documentation in the medical literature of intraarticular levels of flucytosine, and provides further rationale for the use of flucytosine in addition to amphotericin B in patients with Candida arthritis.