How would you approach treatment in a patient with refractory Coccidioidal meningitis who has previously been treated with IV amphotericin B?  

The previous receipt of amphotericin B is irrelevant. Shortly after its introduction in the mid-1950s, it was recognized that it was ineffective in the treatment of coccidioidal meningitis when given intravenously and that intrathecal administration was necessary (Winn, PMID 14065439). The introduct...