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.
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Tucker RM, Denning DW, Dupont B, Stevens DA. Itraconazole Therapy for Chronic Coccidioidal Meningitis. Ann Intern Med. 1990;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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