Richard M. Tucker, MD; David W. Denning, MB; Bertrand Dupont, MD; David A. Stevens, MD
Study Objective: To assess the efficacy of orally administered itraconazole in the treatment of coccidioidal meningitis.
Design: Prospective, nonrandomized open trial.
Setting: Multicenter trial at an urban county hospital, a university referral center, and referring institutions.
Patients: Ten patients with culture or serologic evidence of coccidioidal meningitis refractory to standard therapy. Patients receiving other systemic antifungal therapy were excluded.
Intervention: Itraconazole was administered orally at dosesof 300 to 400 mg/d for a median duration of 10 months. Disease activity and drug efficacy were evaluated at initiation of therapy and at the most recent follow-up using a standardized scoring system.
Measurements and Main Results: Eight of ten patients are evaluable. Of five patients receiving itraconazole as sole therapy, four have responded. All three patients receiving intraamphotericin B have had that therapy discontinued and have no evidence of active disease in the absence of intrathecal therapy. Toxicity has been minimal; one patient had mild nausea.
Conclusions: Itraconazole shows impressive activity in this series of patients with refractory coccidioidal meningitis. Itraconazole in this and other fungal meningitides should be evaluated further.
Tucker RM, Denning DW, Dupont B, Stevens DA. Itraconazole Therapy for Chronic Coccidioidal Meningitis. Ann Intern Med. ;112:108–112. doi: 10.7326/0003-4819-112-2-108
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Published: Ann Intern Med. 1990;112(2):108-112.
CNS Infections, Infectious Disease, Neurology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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