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 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. 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 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.
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 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. 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 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.
Authors: Brahm H Segal; Raoul Herbrecht; David A Stevens; Luis Ostrosky-Zeichner; Jack Sobel; Claudio Viscoli; Thomas J Walsh; Johan Maertens; Thomas F Patterson; John R Perfect; Bertrand Dupont; John R Wingard; Thierry Calandra; Carol A Kauffman; John R Graybill; Lindsey R Baden; Peter G Pappas; John E Bennett; Dimitrios P Kontoyiannis; Catherine Cordonnier; Maria Anna Viviani; Jacques Bille; Nikolaos G Almyroudis; L Joseph Wheat; Wolfgang Graninger; Eric J Bow; Steven M Holland; Bart-Jan Kullberg; William E Dismukes; Ben E De Pauw Journal: Clin Infect Dis Date: 2008-09-01 Impact factor: 9.079
Authors: R Allendoerfer; R R Yates; A J Marquis; D Loebenberg; M G Rinaldi; J R Graybill Journal: Antimicrob Agents Chemother Date: 1992-01 Impact factor: 5.191