Due to the rarity and severity of N. fowleri infection, successful treatment is difficult to confirm. There are reportedly only four survivors of Primary Amoebic Meningoencephalitis (PAM) as a result of N. fowleri infection in North America, with three of these cases stemming from the United States. Death often occurs within 5 to 10 days of infection, so early detection and aggressive treatment are absolutely critical for patient survival.
Physical Intervention
- Hypothermia has been used in a pt who experienced full neurological recovery, but a second survivor was not exposed to this treatment.*
- Ventriculostomy may be required to alleviate increasing intracranial pressure and to avoid herniation.
Recommended Medication*
Drug |
Dose |
Route |
Frequency |
Duration |
Maximum Dose |
Amphotericin B |
1. 1.5 mg/kg in 2 divided doses 2. 1 mg/kg/day 3. 1.5 mg 4. 1 mg/day |
1. Intravenous 2. Intravenous 3. Intrathecal 4. Intrathecal |
1. Per day 2. Once daily 3. Once daily 4. Every other day |
1. 3 days 2. 11 days 3. 2 days 4. 8 days |
1.5 mg/kg/day |
Azithromycin |
10 mg/day |
Intravenous/Oral |
Once daily |
28 days |
500 mg/day |
Fluconazole |
10 mg/kg/day |
Intravenous/Oral |
Once daily |
28 days |
600 mg/day |
Rifampin |
10 mg/kg/day |
Intravenous/Oral |
Once daily |
28 days |
600 mg/day |
Miltefosine |
50 mg |
Oral |
Weight <45kg: 2X daily Weight >45kg: 3X daily |
28 days |
2.5 mg/kg/day |
Dexamethasone |
0.6 mg/kg in 4 divided doses |
Intravenous |
Per day |
4 days |
0.6 mg/kg/day |
*Treatment plan taken from recommended treatment according to the CDC and the pediatricians of a surviving PAM patient