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Itraconazole Therapy for Chronic Coccidioidal Meningitis

Richard M. Tucker, MD; David W. Denning, MB; Bertrand Dupont, MD; and David A. Stevens, MD
[+] Article, Author, and Disclosure Information

Requests for Reprints: David A. Stevens, MD, Department of Medicine, Santa Clara Valley Medical Center, 751 South Bascom Avenue, San Jose, CA 95128.

Current Author Addresses: Dr. Tucker: Department of Medicine, Wenatchee Valley Clinic, 820 North Chelan Street, Wenatchee, WA 98807.

Drs. Denning and Stevens: Department of Medicine, Santa Clara Valley Medical Center, 751 South Bascom Avenue, San Jose, CA 95128.

Dr. Dupont: Pasteur Institute, 25 rue du Docteur Roux, F-75724 Paris, France.

©1990 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1990;112(2):108-112. doi:10.7326/0003-4819-112-2-108
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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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