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).