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Relationship between intracranial pressure and antifungal agents levels in the CSF of patients with cryptococcal meningitis.
- Source :
-
Medical mycology [Med Mycol] 2018 Apr 01; Vol. 56 (3), pp. 257-262. - Publication Year :
- 2018
-
Abstract
- The purpose of this study was to evaluate the influence of intracranial hypertension in the cerebrospinal fluid (CSF) levels of amphotericin B and fluconazole levels of patients with cryptococcal meningitis. CSF samples and intracranial pressure were obtained by means of routine punctures performed at days 1, 7, and 14 of therapy, respectively. Amphotericin B and fluconazole CSF levels were measured by HPLC method as previously described. The minimum inhibitory concentration for amphotericin B, fluconazole, 5΄flucytosine, and voriconazole of each Cryptococcus isolate was performed according to CLSI. The predominant Cryptococcus species found was C. neoformans, and the major underlying condition was AIDS. Only one CSF sample had a detectable level for amphotericin B during the 14 days of therapy. Fluconazole CSF levels progressively increased from day 1 to day 14 of therapy for most cases. Fluconazole levels in the CSF were above the minimum inhibitory concentrations (MICs) for Cryptococcus during the initial 14 days of antifungal therapy. Variations of intracranial pressure did not affect amphotericin B and fluconazole levels in the CSF. The generalized estimating correlation (GEE) and Spearman correlation test (SCT) showed no significant correlation between the amphotericin B or fluconazole concentrations in the CSF and intracranial pressure (P = .953 and P = .093, respectively for GEE test and P = .477 and P = .847, respectively, for SCT). Combination therapy of amphotericin B with fluconazole was effective in 60% of the patients considering CSF cultures were negative in 9 of 15 patients after 14 days of therapy. Further studies are necessary to evaluate the role of intracranial hypertension on the therapeutic efficacy of different antifungal agents in patients with cryptococcal meningitis.
- Subjects :
- AIDS-Related Opportunistic Infections complications
AIDS-Related Opportunistic Infections microbiology
Adult
Aged
Amphotericin B pharmacology
Amphotericin B therapeutic use
Antifungal Agents cerebrospinal fluid
Antifungal Agents pharmacology
Antifungal Agents therapeutic use
Brazil
Child
Cryptococcus isolation & purification
Drug Therapy, Combination
Female
Fluconazole pharmacology
Fluconazole therapeutic use
Flucytosine pharmacology
Follow-Up Studies
Humans
Male
Meningitis, Cryptococcal cerebrospinal fluid
Meningitis, Cryptococcal microbiology
Microbial Sensitivity Tests
Middle Aged
Tertiary Care Centers
Treatment Outcome
Voriconazole pharmacology
Amphotericin B cerebrospinal fluid
Cryptococcus drug effects
Fluconazole cerebrospinal fluid
Intracranial Pressure drug effects
Meningitis, Cryptococcal drug therapy
Meningitis, Cryptococcal physiopathology
Subjects
Details
- Language :
- English
- ISSN :
- 1460-2709
- Volume :
- 56
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Medical mycology
- Publication Type :
- Academic Journal
- Accession number :
- 28992308
- Full Text :
- https://doi.org/10.1093/mmy/myx054