Continuous intrathecal administration of liposomal amphotericin B for treatment of refractory Cryptococcus neoformans encephalitis: A case report

Abstract

Abstract. The aim of the present study was to investigate the treatment of refractory Cryptococcus neoformans encephalitis with continuous administration of liposomal amphotericin B (AmB). Liposomal AmB was administered to a 28-year-old male by intravenous injection, with daily increasing dosages up to 150 mg per day and combined use of fluconazole (0.4 g per day) and oral flucytosine tablets (1.5 g per day). Following 5 months of treatment, C. neoformans could still be detected in the ink stain of cerebrospinal fluid, but the patient could not tolerate a further increase in the dosage of liposomal AmB. Instead, continuous intrathecal administration of AmB through tube drainage on the lumbar cistern was used. A total dosage of 28 mg liposomal AmB was administered to the patient over the course of 1 month. The effect of AmB administered by intravenous injection was not as great as expected and the patient's tolerance was not good. However, the patient recovered following treatment by continuous intrathecal administration of AmB through tube drainage on the lumbar cistern for 1 month. This case suggests that continuous intrathecal administration of liposomal AmB should be considered for clinical treatment of refractory cryptococcal encephalitis.

The blood–CSF–brain route of neurological disease: The indirect pathway into the brain

“…If patients could be identified as having a primarily CSF‐based pathology, this could allow for more targeted treatment, such as direct drug delivery into the CSF. This already occurs with intrathecal chemotherapy in leukaemia [151] and leptomeningeal carcinomatosis [125], intrathecal antimicrobials in cryptococcal meningitis [152,153] and has recently been trialled with intrathecal immunosuppression in primary progressive MS [154]. Intrathecal delivery devices already exist for providing analgesic and antispasmodic medications [155].…”

A Controlled Study of Continuous Lumbar Drainage of Fluid and Lumbar Puncture Drainage for Aneurysmal SAH after Intracranial Aneurysm Clipping

“…After the operation, drug needs to be changed regularly, while the three-way valve should be disinfected regularly and covered with sterile gauze. In addition, the drainage bottle should be elevated before extraction, and the drainage tube should be removed only after the patient has no abnormal manifestations, and silk sutures need to be performed at the puncture site after extraction to prevent cerebrospinal fluid leakage [22].…”

Efficacy and Safety of Amphotericin B with Autologous Serum for Fungal Corneal Ulcer

“…In recent years, the rational selection of antifungal drugs and improving the effectiveness of antifungal drugs have received increasing attention. 12,13 Among them, amphotericin B is a polyene antifungal drug and is a firstline antifungal drug for clinical use. 14 Related data show that amphotericin B is suitable for corneal infection caused by a variety of fungi.…”