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Ketoconazole Treatment of Coccidioidal Meningitis a
Author(s) -
GRAYBILL JOHN R.,
STEVENS DAVID A.,
GALGIANI JOHN N.,
SUGAR ALAN M.,
CRAVEN PHILIP C.,
GREGG CLARK,
HUPPERT MILTON,
CLOUD GRETCHEN,
DISMUKES WILLIAM E.
Publication year - 1988
Publication title -
annals of the new york academy of sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.712
H-Index - 248
eISSN - 1749-6632
pISSN - 0077-8923
DOI - 10.1111/j.1749-6632.1988.tb40446.x
Subject(s) - library science , annals , gerontology , boulevard , center (category theory) , medicine , history , archaeology , chemistry , computer science , crystallography
Fifteen patients with coccidioidal meningitis were treated with high doses of ketoconazole for up to 4 years. Five patients were treated with ketoconazole alone. One clinically failed, one developed hepatotoxicity, and three achieved remission of meningitis. One patient received intrathecal AMB in addition to ketoconazole for only 2 weeks before continuing on ketoconazole alone. He improved, but discontinued ketoconazole because of nausea and vomiting, and suffered a lethal relapse. Nine patients received ketoconazole in combination with prolonged courses of intrathecal AMB. Two patients were failures from nausea and vomiting, and the remaining seven either improved or experienced remission. The clinical responses appeared to be similar in patients receiving high-dose ketoconazole, either alone or combined with AMB, suggesting that there is no clinically significant antagonism of the drugs. Nausea and vomiting are significant limitations of high-dose ketoconazole. Ketoconazole alone is effective in some patients with coccidioidomycotic meningitis.