What is the role of posaconazole for the treatment of coccidioidomycosis?

Updated: Aug 27, 2019
  • Author: Duane R Hospenthal, MD, PhD, FACP, FIDSA, FASTMH; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Posaconazole has been approved by the European Commission as salvage therapy for refractory coccidioidomycosis. [74] Clinical trials are now ongoing for further evaluation. [75, 76, 68]

Anecdotal reports show that 800 mg/day of posaconazole (a derivative of itraconazole) in divided doses was successful and caused relatively few side effects in patients in whom conventional therapy had failed. Long-term therapy (1-2 years) was well-tolerated. In one case series, 2 patients treated with posaconazole experienced symptomatic and laboratory improvement. [73] In another study, 17 of 20 patients with pulmonary and nondisseminated disease responded well to posaconazole 400 mg/day, and no adverse events were noted. [77]

Voriconazole is also being studied in salvage therapy for refractory cases. A case report indicated that voriconazole in combination with amphotericin B as salvage therapy for disseminated coccidioidomycosis was successful. [78]


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