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Survival Improvement in Coccidioidal Meningitis by High-Dose Intrathecal Amphotericin B
Enrique L. Labadie, MD;
Robert H. Hamilton, MD
Arch Intern Med. 1986;146(10):2013-2018.
Abstract
• Eleven patients with coccidioidal meningitis were treated with high individual doses (1.0 to 1.5 mg) of intrathecal amphotericin B mixed with 25 to 50 mg of hydrocortisone in an attempt to reach a dose of 12 mg per month for at least two consecutive months. Patients received a mean intrathecal dose of amphotericin B of 82 mg (range, 40 to 157 mg) and 2.4 g intravenously (range, 1.0 to 3.5 g). No deaths related to disease or treatment occurred, and overall survival was 91% during an average follow-up period of 75 months (range, 30 to 137 months). Comparative analysis with eight well-known series in the literature reveals that our survival rate and follow-up time are significantly greater than the more recent series (19771981). Rank correlation and linear regression showed that the mean intrathecal dose of amphotericin B used in all series corresponds well with mean survival time. Our clinical results and analysis of the literature suggest that intrathecal amphotericin B administered at a high dose rate of 0.75 mg (or greater) three times per week promptly reaching 20 mg and a total surpassing 40 mg is associated with significantly enhanced survival rates.
(Arch Intern Med 1986;146:2013-2018)
Author Affiliations
From the Department of Neurology, Tucson Veterans Administration Medical Center and University of Arizona Health Sciences Center.
Footnotes
Accepted for publication Dec 6, 1985.
Reprint requests to Tucson Veterans Administration Medical Center, S Sixth Ave, Tucson, AZ 85723 (Dr Labadie).
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