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Coccidioidal Meningitis Narcotic—Amphotericin B Intracisternal Therapy-Reply

Enrique L. Labadie, MD; Robert H. Hamilton, MD
Arch Intern Med. 1988;148(4):985-988. doi:10.1001/archinte.1988.00380040225039.
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In Reply.  —It is gratifying to know that high-dose intrathecal amphotericin B has been used on three patients by a neurological group in Phoenix, thus at least corroborating our published report that high single doses can be administered safely and high total dosage can be reached rapidly.Yudell and colleagues offer a personal innovation in the combined use of amphotericin and the opiate, fentanyl, to alleviate instillation discomfort. On receiving their letter to the editor, we tried that combination on a patient with active coccidioidal meningitis who was undergoing therapy. We used 1 mg of amphotericin, and 10 μg of fentanyl as they suggested, as well as 25 mg of hydrocortisone, but avoided the premedication regimen outlined in our article. A total of four direct intracisternal injections were performed. It was noticed that the patient was significantly more apprehensive and restless prior to the first two injections, and we had


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