American Board of Internal Medicine (ABIM) Certification Practice Exam

Which drug is recommended for the treatment of coccidioidal meningitis?

1. Amphotericin B

2. Flucytosine

3. Itraconazole

4. Fluconazole

The correct answer is: Fluconazole

Fluconazole is the recommended treatment for coccidioidal meningitis due to its effectiveness in penetrating the central nervous system and its established utility in treating fungal infections, particularly those caused by Coccidioides species. Coccidioidal meningitis can be a severe manifestation of coccidioidomycosis and requires long-term antifungal therapy to effectively control the infection and prevent complications. Fluconazole works by inhibiting the synthesis of ergosterol, a critical component of fungal cell membranes, thereby disrupting cell integrity and function. This specific mechanism is especially significant in the treatment of Coccidioides, which is known to cause chronic meningitis in some patients. In contrast, while Amphotericin B is a potent antifungal agent used for severe systemic fungal infections, it is less commonly used as a first-line treatment for coccidioidal meningitis due to its side effect profile and the availability of more tolerated oral alternatives like fluconazole. Flucytosine is primarily used as an adjunct therapy in the treatment of cryptococcal meningitis, and Itraconazole is mainly recommended for less severe forms of coccidioidomycosis rather than for meningitis specifically. Thus, fluconazole is the preferred