What is the treatment for chronic progressive 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

Individuals with chronic progressive fibrocavitary pneumonia should immediately start antifungal treatment with an oral azole and continue therapy for at least 1 year. Fluconazole at 400 mg/day and itraconazole at 200 mg twice daily appear to be equivalent in efficacy, but more patients demonstrate a response with itraconazole, which becomes evident at 12 months of therapy.

Doses should be increased or a different azole tried, if necessary, to obtain maximal responses. Amphotericin B is an alternative treatment if there is no response. Surgical resection is an option reserved for patients with refractory disease. Surgery in patients with chronic pulmonary coccidioidal infection is not uniformly curative and may result in serious complications. The potential complications of surgery include the development of postoperative bronchopleural fistula and postoperative cavity formation.


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