Miconazole therapy for fungal meningitis

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 microgram/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 microgram/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.