Itraconazole Therapy for Chronic Coccidioidal Meningitis

Abstract

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 disese 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.