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Fluconazole Failure in the Treatment of Coccidioidal Meningitis

Introduction: Coccidioidal meningitis (CM) is the most lethal form of disseminated coccidioidomycosis. Current guidelines recommend fluconazole as initial therapy but there has been a paucity of data regarding failure of fluconazole and optimal fluconazole dosage in the treatment of CM. We conducted...

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Autores principales: Gupta, Simran, Ampel, Neil M., Klanderman, Molly, Grill, Marie F., Blair, Janis E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9697806/
https://www.ncbi.nlm.nih.gov/pubmed/36354924
http://dx.doi.org/10.3390/jof8111157
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author Gupta, Simran
Ampel, Neil M.
Klanderman, Molly
Grill, Marie F.
Blair, Janis E.
author_facet Gupta, Simran
Ampel, Neil M.
Klanderman, Molly
Grill, Marie F.
Blair, Janis E.
author_sort Gupta, Simran
collection PubMed
description Introduction: Coccidioidal meningitis (CM) is the most lethal form of disseminated coccidioidomycosis. Current guidelines recommend fluconazole as initial therapy but there has been a paucity of data regarding failure of fluconazole and optimal fluconazole dosage in the treatment of CM. We conducted this study to understand risk factors for fluconazole failure. Methods: We conducted a single-center retrospective chart review of patients diagnosed with coccidioidal meningitis between 1 January 1988 and 15 May 2021. Relevant demographic and clinical variables were collected, along with outcomes including treatment failure and death at any point. Univariate tests were conducted using the chi-squared goodness of fit test and analysis of variance. Results: Among 71 patients who began treatment for CM with fluconazole, 22 (31%) developed worsening meningitis at a median time of 206 days. Longer time from symptom onset to diagnosis of CM was a risk factor for fluconazole failure. Although the absolute failure rate of fluconazole starting dose of 400 mg daily was higher than that of 800 mg daily, the differences did not achieve statistical significance (p = 0.39). Conclusion: Fluconazole failure is not uncommon in the treatment of CM. A dose of 800 mg daily was not superior to a dose of 400 mg daily. All patients on fluconazole for CM require close monitoring.
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spelling pubmed-96978062022-11-26 Fluconazole Failure in the Treatment of Coccidioidal Meningitis Gupta, Simran Ampel, Neil M. Klanderman, Molly Grill, Marie F. Blair, Janis E. J Fungi (Basel) Brief Report Introduction: Coccidioidal meningitis (CM) is the most lethal form of disseminated coccidioidomycosis. Current guidelines recommend fluconazole as initial therapy but there has been a paucity of data regarding failure of fluconazole and optimal fluconazole dosage in the treatment of CM. We conducted this study to understand risk factors for fluconazole failure. Methods: We conducted a single-center retrospective chart review of patients diagnosed with coccidioidal meningitis between 1 January 1988 and 15 May 2021. Relevant demographic and clinical variables were collected, along with outcomes including treatment failure and death at any point. Univariate tests were conducted using the chi-squared goodness of fit test and analysis of variance. Results: Among 71 patients who began treatment for CM with fluconazole, 22 (31%) developed worsening meningitis at a median time of 206 days. Longer time from symptom onset to diagnosis of CM was a risk factor for fluconazole failure. Although the absolute failure rate of fluconazole starting dose of 400 mg daily was higher than that of 800 mg daily, the differences did not achieve statistical significance (p = 0.39). Conclusion: Fluconazole failure is not uncommon in the treatment of CM. A dose of 800 mg daily was not superior to a dose of 400 mg daily. All patients on fluconazole for CM require close monitoring. MDPI 2022-11-01 /pmc/articles/PMC9697806/ /pubmed/36354924 http://dx.doi.org/10.3390/jof8111157 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Brief Report
Gupta, Simran
Ampel, Neil M.
Klanderman, Molly
Grill, Marie F.
Blair, Janis E.
Fluconazole Failure in the Treatment of Coccidioidal Meningitis
title Fluconazole Failure in the Treatment of Coccidioidal Meningitis
title_full Fluconazole Failure in the Treatment of Coccidioidal Meningitis
title_fullStr Fluconazole Failure in the Treatment of Coccidioidal Meningitis
title_full_unstemmed Fluconazole Failure in the Treatment of Coccidioidal Meningitis
title_short Fluconazole Failure in the Treatment of Coccidioidal Meningitis
title_sort fluconazole failure in the treatment of coccidioidal meningitis
topic Brief Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9697806/
https://www.ncbi.nlm.nih.gov/pubmed/36354924
http://dx.doi.org/10.3390/jof8111157
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