Which antifungal is often used in combination with amphotericin B to treat cryptococcal meningitis?

Flucytosine is frequently used in combination with amphotericin B to treat cryptococcal meningitis, particularly in patients with HIV/AIDS. This combination therapy is effective because amphotericin B is a polyene antifungal that binds to ergosterol in the fungal cell membrane, creating pores that lead to cell death. Flucytosine, on the other hand, is an antifungal that enters fungal cells and interferes with nucleic acid synthesis by inhibiting thymidylate synthase. This dual mechanism of action helps to achieve better antifungal efficacy and reduces the likelihood of resistance developing.

In cryptococcal meningitis, the use of both medications not only enhances the antifungal effect but also helps to reduce the risk of treatment failure. This is particularly important in severe cases of meningitis, where both rapid and effective treatment is essential to improve patient outcomes.

The other agents mentioned are effective antifungals but are not typically utilized specifically for cryptococcal meningitis in combination with amphotericin B. For instance, voriconazole and posaconazole are primarily used for invasive aspergillosis and other mold infections, while terbinafine is best known for treating dermatophyte infections and onychomycosis