Treatment of coccidioidal meningitis with fluconazole.

Fluconazole was administered at doses of 50-400 mg/d to 18 patients (15 men, three women) with coccidioidal meningitis. After a mean duration of treatment of 9.8 months, 10 (67%) of 15 assessable patients had responded, one (7%) of 15 had partially responded, and four (27%) of 15 had not responded to therapy. Five (63%) of eight assessable patients receiving fluconazole as sole therapy responded or partially responded. Two patients discontinued fluconazole after initially responding to therapy, and both experienced relapse. The toxicity of fluconazole remains minimal at doses to 400 mg/d. The penetration of fluconazole into cerebrospinal fluid is substantial at all doses studied. Thus fluconazole continues to show promise even as sole therapy against coccidioidal meningitis. Not all patients respond, however, and relapse may be a problem with the currently studied doses and durations of therapy.

[1]  R. M. Tucker,et al.  Itraconazole therapy for chronic coccidioidal meningitis. , 1990, Annals of internal medicine.

[2]  R. M. Tucker,et al.  Itraconazole therapy for cryptococcal meningitis and cryptococcosis. , 1989, Archives of internal medicine.

[3]  R. M. Tucker,et al.  Treatment of Mycoses with Itraconazole , 1988, Annals of the New York Academy of Sciences.

[4]  D. Hanger,et al.  Fluconazole and testosterone: in vivo and in vitro studies , 1988, Antimicrobial Agents and Chemotherapy.

[5]  A. Catanzaro,et al.  Fluconazole Penetration into Cerebrospinal Fluid in Humans , 1988, Journal of clinical pharmacology.

[6]  R. M. Tucker,et al.  Pharmacokinetics of fluconazole in cerebrospinal fluid and serum in human coccidioidal meningitis , 1988, Antimicrobial Agents and Chemotherapy.

[7]  H. Britton,et al.  Imidazole therapy of coccidioidal meningitis in children , 1988, The Pediatric infectious disease journal.

[8]  J. Galgiani,et al.  Pharmacology and toxicity of high-dose ketoconazole , 1987, Antimicrobial Agents and Chemotherapy.

[9]  J. Galgiani,et al.  Coccidioidomycosis in the acquired immunodeficiency syndrome. , 1987, Annals of internal medicine.

[10]  J. Perfect,et al.  Comparison of itraconazole and fluconazole in treatment of cryptococcal meningitis and candida pyelonephritis in rabbits , 1986, Antimicrobial Agents and Chemotherapy.

[11]  J. Graybill,et al.  Treatment of murine coccidioidal meningitis with fluconazole (UK 49,858). , 1986, Journal of medical and veterinary mycology : bi-monthly publication of the International Society for Human and Animal Mycology.

[12]  M J Humphrey,et al.  Pharmacokinetic evaluation of UK-49,858, a metabolically stable triazole antifungal drug, in animals and humans , 1985, Antimicrobial Agents and Chemotherapy.

[13]  J. Perfect,et al.  Penetration of imidazoles and triazoles into cerebrospinal fluid of rabbits. , 1985, The Journal of antimicrobial chemotherapy.

[14]  R. Hershberger,et al.  Treatment of central nervous system fungal infection with ketoconazole. , 1985, Archives of internal medicine.

[15]  J. Graybill,et al.  High-dose ketoconazole for treatment of fungal infections of the central nervous system. , 1983, Annals of internal medicine.

[16]  D. Stevens,et al.  Experience with ketoconazole in three major manifestations of progressive coccidioidomycosis. , 1983, The American journal of medicine.

[17]  D. Stevens,et al.  Ketoconazole blocks testosterone synthesis. , 1982, Archives of internal medicine.

[18]  D. Stevens,et al.  Ketoconazole blocks adrenal steroid synthesis. , 1982, Annals of internal medicine.

[19]  N. Carnevale,et al.  Amphotericin B-induced myelopathy. , 1980, Archives of internal medicine.

[20]  D. Stevens Chemotherapy of Coccidioidomycosis , 1980 .

[21]  J. Galgiani,et al.  Treatment of fungal meningitis with miconazole. , 1977, Archives of internal medicine.

[22]  J. Keane Cisternal puncture complications. Treatment of coccidioidal meningitis with amphotericin B. , 1973, California medicine.

[23]  J. Graybill,et al.  Complications with the Ommaya reservoir in patients with granulomatous meningitis. , 1973, Journal of neurosurgery.

[24]  W. Winn The use of amphotericin B in the treatment of coccidioidal disease. , 1959, The American journal of medicine.

[25]  T. Gibson,et al.  Coccidioidomycosis of the meninges. , 1950, California medicine.