What is the treatment for disseminated 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

All patients with disseminated coccidioidomycosis warrant prolonged antifungal treatment. Therapy for nonmeningeal extrapulmonary disease can be initiated with oral azoles unless the disease is rapidly progressive or in a critical location (such as the vertebral column); in such situations, the alternative therapy is amphotericin B.

Some authors suggest initial therapy with amphotericin B until significant clinical, radiographic, and laboratory test (in particular, CF IgG titers) improvements are documented, followed by completion of the antifungal regimen with an oral azole. Fluconazole and itraconazole are the most commonly used azoles, at doses from 400-2000 mg/day for fluconazole and up to 800 mg/day for itraconazole.

In patients who warrant amphotericin B therapy but have drug-related toxicities, lipid amphotericin B formulations can be considered and have been effective in animal models, although no human clinical trials have assessed their efficacy. Combination therapy with amphotericin B and an azole has been reported, but no clinical trials have demonstrated its superiority to single-agent treatment, and antagonism with combination therapy has been reported for other fungal infections.


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