What is the treatment for diffuse pneumonia in 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

Initially, treat patients with diffuse pulmonary disease (ie, miliary or reticulonodular infiltrates) with amphotericin B or high-dose fluconazole for several weeks until definite signs of improvement are observed. If there is rapid deterioration or significant hypoxia, amphotericin B is used more frequently.

After clear evidence of improvement emerges, therapy may be changed to an oral azole to complete a prolonged course of antifungal therapy. Because these patients are often immunocompromised, the total duration of therapy should be at least 1 year, with secondary prophylaxis continuing indefinitely for subgroups of patients who are severely immunodeficient.

In a retrospective study of oral azole therapy in 224 patients with moderately severe pulmonary disease who received treatment within 30 days of onset of symptoms versus 30 days after the onset of symptoms, the incidence of dissemination and the need for antifungal therapy longer than 1 year were significantly reduced in the group who received early treatment with azoles, but the mortality reduction was insignificant. [37]

In the same study, only 27% of patients developed a complement-fixation titer greater than 1:32 (vs 45% in the group who received late treatment with azoles). These results suggest that in patients with moderately severe pulmonary disease, institution of early or azole therapy should be considered. Further study is needed to confirm this finding. [37]


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