重症クリプトコックス髄膜炎に対するＡｍｐｈｏｔｅｒｉｃｉｎ　Ｂの長期脳室内投与の有用性についての検討

DOI 被引用文献1件 オープンアクセス

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  • Successful treatment of serious cryptococcal meningitis by intraventricular administration of amphotericin B.

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Two cases of serious cryptococcal meningitis refractory to flucytosine or miconazole were successfully treated with intraventricular administration of amphotericin B. Case 1. A 69-year-old man was admitted complaining of consciousness disturbance and left oculomotor palsy. He was treated with flucytosine orally and amphotericin B intravenously and intraventricularly via Ommaya reservoir as soon as cryptococci had been proved in the CSF. After 40 days of this combined therapy, cryptococci had disappeared in the CSF, but reappeared after the administration of amphotericin B was discontinued. Intraventricular administration of amphotericin B was therefore resumed for 5 month period, a total of 62 administrations and 32.75mg, until the patient was cured. Case 2. A 61-year-old man was hospitalized for loss of consciousness and respiratory disturbance. He was administered flucytosine orally and miconazole intravenously and intraventricularly via Ommaya reservoir, and cryptococci disappeared in the CSF within 10 days. Cryptococci, however, reappeared and he became comatose. Then, the addition of the intraventricular administration of amphotericin B led to the complete disappearance of cryptococci on cerebrospinal smears. Unfortunately, the patient subsequently died of serious liver dysfunction and gastro-intestinal bleeding.<BR>Measurement of amphotericin B concentrations in serum and CSF revealed its poor CSF penetration, and high CSF concentration remained for eight hours after intraventricular administration of amphotericin B. Although flucytosine and miconazole have no untoward side effects in a long-term therapy, the easy development of resistance is a serious limiting factor. Therefore, it is considered that intraventricular administration of amphotericin B via Ommaya reservoir introduced into the lateral ventricle is more useful and efficient for the treatment of serious cryptococcal meningitis.

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