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Treatment of Fungal Meningitis With Miconazole

Treatment of Fungal Meningitis With Miconazole Abstract Twelve patients with fungal meningitis (ten cases were due to Coccidioides immitis, two were from Cryptococcus neoformans) were treated with brief courses of intravenous (IV) miconazole. Eleven patients, including patients with severe, chronic disease, had been treated unsuccessfully with amphotericin B. Four patients also received miconazole injected directly into the CSF. The drug was well tolerated by any route, with mild reversible side effects. After IV administration the miconazole concentration in the CSF rarely exceeded the minimal inhibitory concentration (MIC) of the infecting organism. Intra-CSF administration of 20 mg generally produced levels above the MIC for 24 hours. Five of ten patients with coccidioidal meningitis responded clinically. Of these five, four received only IV miconazole; three relapsed after therapy was stopped. Miconazole appears promising as a treatment of fungal meningitis, but trials of longer duration might prevent relapse. (Arch Intern Med 137:1180-1185, 1977) References 1. Bennett JE: Chemotherapy of systemic mycoses . N Engl J Med 290:30-32, 320-322, 1974.Crossref 2. Shadomy S: In vitro studies with 5-fluorocytosine . Appl Microbiol 17:871-877, 1969. 3. Shadomy S: Further in vitro studies with 5-fluorocytosine . Infect Immun 4:143-148, 1971. 4. Bindschadler DD, Bennett JE: A pharmacologic guide to the clinical use of amphotericin B . J Infect Dis 120:427-436, 1969.Crossref 5. Abernathy RS: Treatment of systemic mycoses . Medicine (Baltimore) 52:385-394, 1973.Crossref 6. Stevens DA, Levine HB, Deresinski SC: Miconazole in coccidioidomycosis—therapeutic and pharmacologic studies in man . Am J Med 60:191-202, 1976.Crossref 7. Caudill RG, Smith CE, Reinarz JA: Coccidioidal meningitis—a diagnostic challenge . Am J Med 49:360-364, 1970.Crossref 8. Holt RJ: Recent developments in antimycotic chemotherapy . Infect Immun 2:95-107, 1974.Crossref 9. Van Cutsem JM, Thienpont D: Miconazole, a broad-spectrum antimycotic agent with antibacterial activity . Chemotherapy 17:392-404, 1972.Crossref 10. Einstein HE, Holeman CW, Sandidge LL, et al: Coccidioidal meningitis—the use of amphotericin B in treatment . Calif Med 94:339-343, 1961. 11. Littman ML, Zimmerman LE: Cryptococcosis (Torulosis) . New York, Grune & Stratton Inc, 1956. 12. Winn WA: Coccidioidal meningitis: A follow-up report , in L Ajello (ed): Proceedings of the Second Coccidioidomycosis Symposium, Phoenix, Arizona, 1965 . Tucson, University of Arizona Press, 1967, pp 55-61. 13. Hoeprich PD, Goldstein E: Miconazole therapy for coccidioidomycosis . JAMA 230:1153-1157, 1974.Crossref 14. Barza M, Brown RB, Shanks C, et al: Relation between lipophilicity and pharmacological behavior of minocycline, doxycycline, tetracycline and oxytetracycline in dogs . Antimicrob Agents Chemother 8:713-720, 1975.Crossref 15. Marmion LC, Desser KB, Lilly RB, et al: Miconazole induced thrombocytosis and anemia . Clin Res 24:93A, 1976. 16. Jackson CW, Simone JV, Edwards CC: Relationship of anemia and thrombocytosis . J Lab Clin Med 84:357-368, 1974. 17. Brugmans J, Van Cutsem J, Heykants J, et al: Systemic antifungal potential, safety, biotransport and transformation of miconazole nitrate . Eur J Clin Pharmacol 5:93-99, 1972.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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References (18)

Publisher
American Medical Association
Copyright
Copyright © 1977 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1977.03630210054018
Publisher site
See Article on Publisher Site

Abstract

Abstract Twelve patients with fungal meningitis (ten cases were due to Coccidioides immitis, two were from Cryptococcus neoformans) were treated with brief courses of intravenous (IV) miconazole. Eleven patients, including patients with severe, chronic disease, had been treated unsuccessfully with amphotericin B. Four patients also received miconazole injected directly into the CSF. The drug was well tolerated by any route, with mild reversible side effects. After IV administration the miconazole concentration in the CSF rarely exceeded the minimal inhibitory concentration (MIC) of the infecting organism. Intra-CSF administration of 20 mg generally produced levels above the MIC for 24 hours. Five of ten patients with coccidioidal meningitis responded clinically. Of these five, four received only IV miconazole; three relapsed after therapy was stopped. Miconazole appears promising as a treatment of fungal meningitis, but trials of longer duration might prevent relapse. (Arch Intern Med 137:1180-1185, 1977) References 1. Bennett JE: Chemotherapy of systemic mycoses . N Engl J Med 290:30-32, 320-322, 1974.Crossref 2. Shadomy S: In vitro studies with 5-fluorocytosine . Appl Microbiol 17:871-877, 1969. 3. Shadomy S: Further in vitro studies with 5-fluorocytosine . Infect Immun 4:143-148, 1971. 4. Bindschadler DD, Bennett JE: A pharmacologic guide to the clinical use of amphotericin B . J Infect Dis 120:427-436, 1969.Crossref 5. Abernathy RS: Treatment of systemic mycoses . Medicine (Baltimore) 52:385-394, 1973.Crossref 6. Stevens DA, Levine HB, Deresinski SC: Miconazole in coccidioidomycosis—therapeutic and pharmacologic studies in man . Am J Med 60:191-202, 1976.Crossref 7. Caudill RG, Smith CE, Reinarz JA: Coccidioidal meningitis—a diagnostic challenge . Am J Med 49:360-364, 1970.Crossref 8. Holt RJ: Recent developments in antimycotic chemotherapy . Infect Immun 2:95-107, 1974.Crossref 9. Van Cutsem JM, Thienpont D: Miconazole, a broad-spectrum antimycotic agent with antibacterial activity . Chemotherapy 17:392-404, 1972.Crossref 10. Einstein HE, Holeman CW, Sandidge LL, et al: Coccidioidal meningitis—the use of amphotericin B in treatment . Calif Med 94:339-343, 1961. 11. Littman ML, Zimmerman LE: Cryptococcosis (Torulosis) . New York, Grune & Stratton Inc, 1956. 12. Winn WA: Coccidioidal meningitis: A follow-up report , in L Ajello (ed): Proceedings of the Second Coccidioidomycosis Symposium, Phoenix, Arizona, 1965 . Tucson, University of Arizona Press, 1967, pp 55-61. 13. Hoeprich PD, Goldstein E: Miconazole therapy for coccidioidomycosis . JAMA 230:1153-1157, 1974.Crossref 14. Barza M, Brown RB, Shanks C, et al: Relation between lipophilicity and pharmacological behavior of minocycline, doxycycline, tetracycline and oxytetracycline in dogs . Antimicrob Agents Chemother 8:713-720, 1975.Crossref 15. Marmion LC, Desser KB, Lilly RB, et al: Miconazole induced thrombocytosis and anemia . Clin Res 24:93A, 1976. 16. Jackson CW, Simone JV, Edwards CC: Relationship of anemia and thrombocytosis . J Lab Clin Med 84:357-368, 1974. 17. Brugmans J, Van Cutsem J, Heykants J, et al: Systemic antifungal potential, safety, biotransport and transformation of miconazole nitrate . Eur J Clin Pharmacol 5:93-99, 1972.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Sep 1, 1977

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