Acetazolamide Therapy and Intracranial Pressure

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Abstract
SIR—We read with interest the article entitled “A Randomized, Double-Blind, Placebo-Controlled Trial of Acetazolamide for the Treatment of Elevated Intracranial Pressure in Cryptococcal Meningitis” by Newton et al. [1], which evaluated the addition of acetazolamide to standard regimens for cryptococcal meningitis. This important study question is frequently raised not only of patients with cryptococcal meningitis, but also of those with CNS coccidioidomycosis. Though their study was ended because of unacceptable electrolyte abnormalities and adverse events, Newton et al. [1] postulated that there may be subsets of patients who would benefit from the use of acetazolamide. We concur that this is likely and report our experience using acetazolamide to treat 2 patients with persistent, symptomatic elevation of intracranial pressure (ICP) following completion of antifungal therapy for fungal meningitis.