Itraconazole therapy for chronic coccidioidal meningitis.
OBJECTIVE
To assess the efficacy of orally administered itraconazole in the treatment of coccidioidal meningitis.


METHODS
Prospective, nonrandomized open trial.


METHODS
Multicenter trial at an urban county hospital, a university referral center, and referring institutions.


METHODS
Ten patients with culture or serologic evidence of coccidioidal meningitis refractory to standard therapy. Patients receiving other systemic antifungal therapy were excluded.


METHODS
Itraconazole was administered orally at doses of 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.


RESULTS
Eight of ten patients are evaluable. Of five patients receiving itraconazole as sole therapy, four have responded. All three patients receiving intrathecal amphotericin 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
R M
RM
Santa Clara Valley Medical Center, California.
Denning
D W
DW
Dupont
B
B
Stevens
D A
DA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000908:Antibodies, Fungal / Q000134:cerebrospinal fluid; D000935:Antifungal Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002908:Chronic Disease; D003047:Coccidioidomycosis / Q000134:cerebrospinal fluid / Q000188:drug therapy*; D005260:Female; D006801:Humans; D017964:Itraconazole; D007654:Ketoconazole / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics / Q000627:therapeutic use; D007958:Leukocyte Count / Q000187:drug effects; D008297:Male; D008581:Meningitis / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000382:microbiology; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011446:Prospective Studies
D000908:Antibodies, Fungal; D000935:Antifungal Agents; D017964:Itraconazole; D007654:Ketoconazole