Use of a Hyperbaric Solution for Administration of Intrathecal Amphotericin B

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Abstract
Repeated intrathecal administration of amphotericin B is often used in treatment of patients with fungal meningitis, but cisternal injections are hazardous and lumbar injection may cause local arachnoiditis. To study the distribution of hyperbaric solutions of amphotericin in 10 per cent dextrose in water, such solutions mixed with 131I albumin were injected into the lumbar space of 21 monkeys, and external radioactivity was monitored to estimate the amount of injected material that reached the cisterna magna. Higher cisternal concentrations of radioisotope were found in the 12 monkeys that were injected with hyperbaric material and then placed in the Trendelenburg position than in nine monkeys that were supine and given non-hyperbaric amphotericin solutions. This technic may prove useful in treatment of fungal meningitis. (N Engl J Med 290:641–646, 1974)