Medical Treatment of Fungal Meningitis in Children

  • Amphotericin B or fluconazole: Fungal meningitis is treated acutely with either intravenous amphotericin B (0.5-1.0 mg/kg/day dosed once daily), or fluconazole, which may be administered either intravenously or orally (12 mg/kg loading dose, followed by 6-12 mg/kg/day with dosing and dose intervals adjusted for neonates – maximum dose 12 mg/kg/24 hours). In patients with HIV, suppressive therapy will be continued for life. Candida meningitis is treated with intravenous amphotericin B with possible addition of flucytosine, with a typical duration of 30 days (2, 65). Persistently positive cultures after several days of adequate therapy predict increased risk of morbidity and mortality (65).
  • Cryptococcal infection in immunocompromised patients requires rapid treatment: Cryptococcal infections commonly seen in immunocompromised patients with HIV or in patients with immunosuppression for bone marrow or solid organ transplantation require rapidly fungicidal induction treatment with amphotericin B in conjunction with flucytosine (100 mg/kg/daily) followed by maintenance therapy with fluconazole for life or until return of normal immune function (58). Corticosteroids may help with control of cerebral edema (65).