Intrathecal Amphotericin B: A 60-Year Experience in Treating Coccidioidal Meningitis.

Ellie J C Goldstein, Jackie Ho, Pete Fowler, Arash Heidari, Royce H Johnson

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2017 Feb 15

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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). © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Citation

Ellie J C Goldstein, Jackie Ho, Pete Fowler, Arash Heidari, Royce H Johnson. Intrathecal Amphotericin B: A 60-Year Experience in Treating Coccidioidal Meningitis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2017 Feb 15;64(4):519-524