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—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
Labadie EL, Hamilton RH. Coccidioidal Meningitis Narcotic—Amphotericin B Intracisternal Therapy-Reply. Arch Intern Med. 1988;148(4):985-988. doi:10.1001/archinte.1988.00380040225039