Miconazole Therapy for Fungal Meningitis

Abstract

• Eight patients with fungal meningitis (5 with the coccidioidal type, 2 with cryptococcal, and 1 with histoplasmosis) were treated with intravenous (IV) and intrathecal (IT) miconazole after previous therapy with amphotericin B proved unsuccessful. Miconazole was well tolerated with both IV and IT administration. The CSF concentration of miconazole one hour after an IV infusion of 800 mg was 0.1 to 0.3 μ/ml. When 20 mg of miconazole was administered intrathecally via lumbar injection in patients with coccidioidal meningitis, 6.5, 2.4, 0.77, and 0.24 μg/ml, respectively, was found in the CSF at the cisternal level at 12, 24, 48, and 72 hours, respectively. Miconazole is apparently an effective fungistatic drug of low toxicity and is a potentially useful agent in the treatment of systemic mycoses and fungal meningitis, in particular.