The optimal approach to the treatment of infections by N. fowleri has not been determined. Since the disease is rare, difficult to diagnose, and rapid in its clinical course, no studies have been done to determine the effectiveness of a single drug or the use of a combination of drugs. To date, the following drugs have been primarily used, either alone or in combinations: amphotericin B, rifampin, fluconazole, azithromycin, dexamethasone, and miltefosine. The most commonly recommended regimen is amphotericin B plus rifampin. However, in 2013 a 12-year-old girl from Arkansas survived and recovered after treatment with amphotericin B and miltefosine, a novel anti-leishmanial drug originally developed to treat breast cancer. The same treatment was successfully used again in 2016 for a 16-year-old boy who became the fourth PAM survivor in the United States.9
