Flucytosine is an oral antifungal agent that is used with amphotericin B for serious Candida and Cryptococcus infections. It works by penetrating fungal cells and interfering with fungal RNA and protein synthesis. However, it is generally used second-line and its use is limited by its toxicities. Flucytosine should be used with extreme caution in patients with kidney dysfunction and dose adjustments are required. It should also be used with caution in patients with bone marrow depression, hematologic disease, or who have been treated with radiation or drugs that suppress the bone marrow.

Unfortunately, most of the antifungals used for Candida albicans are not effective against other types of Candida, which are often the culprits of recurrent infections. In other words, since the common antifungals do not work against resistant fungi, the infection will never be fully eradicated. Candida glabrata is particularly common in recurrent episodes and should be treated with one of the following, as they have been used successfully:

• Flucytosine 100 mg/kg daily given in 4 divided doses every 6 hours for 14 days
• Amphotericin B 50 mg vaginal suppositories for 14 days

• Berberine (as Berberine HCI) 400 mg
• Caprylic Acid (as Caprylic Oil) 300 mg
• Olive (Olea europaea) Leaf Extract 333 mg
• Grapefruit (Citrus paradisi) Seed Extract 250 mg
• Garlic (Allium sativum) Bulb 250 mg
• Neem Leaf Powder 200 mg
• Thyme (Thymus vulgaris) Aerial Extract 100 mg
• Oregano (Origanum vulgare) Aerial Extract 100 mg

Take each dose with a full glass (8 ounces) of water.

Flucytosine may cause nausea and vomiting. If you take more than one capsule per dose, swallow one capsule at a time over a 15-minute period to help prevent nausea and vomiting.