Itraconazole therapy for chronic coccidioidal meningitis.

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.