Intraventricular administration of amphotericin B. Use of subcutaneous reservoir in four patients with mycotic meningitis

Abstract

In four cases of fungal meningitis, three due to Cryptococcus neoformans and one due to Coccidioides immitis, repeated doses of amphotericin B were given by needle injection into a subcutaneously placed, silicone-rubber reservoir attached to a catheter which passed through a burr-hole and the brain substance into a lateral ventricle (Ommaya reservoir). One patient with cryptococcal meningitis died of overwhelming infection after receiving amphotericin B, first intravenously and later by 15 injections into the reservoir. Two patients with cryptococcal and one with coccidioidal meningitis improved after amphotericin B treatment which included 21 to 74 injections into the reservoir.