American Board of Internal Medicine (ABIM) Certification Practice Exam

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What is the treatment of choice for Coccidioides immitis meningitis?

Ampicillin
Fluconazole
Voriconazole
Rifampin

The correct answer is: Fluconazole

The treatment of choice for Coccidioides immitis meningitis is fluconazole. This antifungal medication is effective against the species in the Coccidioides genus and is particularly important in managing central nervous system infections, such as meningitis caused by this pathogen. Fluconazole is favored due to its good penetration into the central nervous system, which is vital for treating meningitis effectively. It also has a favorable safety profile and is often used as an oral medication, making it convenient for long-term treatment, which is typically necessary for fungal meningitis. In contrast, options like ampicillin, voriconazole, and rifampin do not provide the appropriate coverage or are less effective for treating Coccidioides immitis. Ampicillin is primarily effective against bacterial infections, while voriconazole is generally used for other fungal infections, specifically related to Aspergillus and Candida species, and isn't particularly indicated for Coccidioides. Rifampin is an antibiotic used mainly for mycobacterial infections, such as tuberculosis, and does not have efficacy against fungal pathogens. Thus, fluconazole stands out as the most effective and appropriate choice for addressing Coccidioides immitis meningitis.