Table 1.

Drugs administered to a patient with Balamuthia mandrillaris granulomatous amebic encephalitis, United States, 2010

Drug	Initiation Date (Hospital Admission Day)	Duration	Dose	Comments
Dexamethasone	Day 1	25 days	4mg IV every 6 hours, slowly tapered	Anti-inflammatory drug for cerebral edema
Fosphenytioin	Day 1	4 days	100 mg IV every 12 hours	Anticonvulsant drug
Liposomal amphotericin B	Day 2	3 days	380 mg IV daily (10 mg/kg/day)	Anti-amebic drug; first administered at initial suspicion of GAE, discontinued in favor of more specific anti-Balamuthia therapy
Azithromycin	Day 3	58 days	750 mg IV daily	Anti-amebic drug
Fluconazole	Day 3	58 days	400 mg IV daily	Anti-amebic drug adjusted for renal insufficiency
5-fluorocytosine (5FC)	Day 3	58 days	1000 to 1425 mg per nasogastric tube (NG) every 6 hours	Anti-amebic drug adjusted based on levels
Pentamidine	Day 3	23 days	160 mg IV daily	Anti-amebic drug discontinued due to pancreatitis and electrolyte problems
Sulfadiazine	Day 3	58 days	500 mg PO and NG every 6 hours	Anti-amebic drug
Levetiracetam	Day 5	12 days	400mg IV every 12 hours	Anticonvulsant drug
Miltefosine	Day 7	26.5 days	50 mg NG twice daily (2.65 mg/kg/day)	Anti-amebic drug discontinued prior to death due to progression of neurologic deterioration, development of multiple organ dysfunction due to presumed drug toxicities, and uncertainty of the contributing role of miltefosine to these toxicities
Phenobarbital	Day 14	6 days	55 to 110 mg IV every 12 hours	Anticonvulsant drug
Valproate	Day 20	4 days	500 mg IV every 12 hours	Anticonvulsant drug
Lorazapam	Day 21	23 days	1.0–2.5 mg IV every 8 hrs, with additional doses as required	Anticonvulsant drug
Metronidazole	Day 22	39 days	370 mg IV every 6 hours	Anti-amebic drug for a new brain lesion discovered on MRI on Day 20
Thioridazine	Day 26	35 days	15 mg NG twice daily	Anti-psychotic drug and might also have anti-amebic activity
Methylprednisolone	Day 47	14 days	20 mg IV every 6 hours	Anti-inflammatory drug for cerebral edema