title: Intrathecal Amphotericin B: A 60-Year Experience in Treating Coccidioidal Meningitis.
abstract: Coccidioidal meningitis (CM) is a devastating complication of coccidioidomycosis. Since the late 1950s, intrathecal (IT) amphotericin B deoxycholate (AmBd) has been successfully used to treat and often cure this disease, reducing mortality rates from 100% to approximately 30%. The introduction of azoles further revolutionized the treatment of coccidioidal infections. However, IT AmBd remains the only known curative option in the management of CM. While the use of IT AmBd is well described in many articles, few discuss the actual methods behind preparation, titration, and dosing strategies utilized. The practitioners at Kern Medical (Bakersfield, California) have >60 years of experience in the utilization of IT AmBd and the treatment of CM. This article describes the practice experience in the treatment of CM, preparation of IT AmBd, and the different dosing strategies used in regard to route of administration (ie, cisternal, lumbar, ventricular).
authors.affiliation: Department of Pharmacy,  Kern Medical, Bakersfield, California, USA.
authors.forename: Jackie
authors.initials: J
authors.lastname: Ho
authors.affiliation: Department of Pharmacy,  Kern Medical, Bakersfield, California, USA.
authors.forename: Pete
authors.initials: P
authors.lastname: Fowler
authors.affiliation: Department of Medicine, Kern Medical, Bakersfield, California, USA.|David Geffen School of Medicine, University of California, Los Angeles, California, USA.
authors.forename: Arash
authors.initials: A
authors.lastname: Heidari
authors.affiliation: Department of Medicine, Kern Medical, Bakersfield, California, USA.|David Geffen School of Medicine, University of California, Los Angeles, California, USA.
authors.forename: Royce H
authors.initials: RH
authors.lastname: Johnson
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000008:administration & dosage*; D003047:Coccidioidomycosis / Q000188:drug therapy*; D006801:Humans; D007278:Injections, Spinal / Q000379:methods*; D008581:Meningitis / Q000188:drug therapy*
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B
keywords: Coccidioidal meningitis; amphotericin; azole therapy; fungal infection; intrathecal therapy