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• Coccidioidomycosis Return to Top

• 1.Primary pulmonary infection in patients low risk persistence/complication: Antifungal treatment not generally recommended. Treat fever weight loss and/or fatigue.

• 1.1 Primary pulmonary infection in patients with increased risk of complications or dissemination:

• Mild to moderate severity.Preferred regimen: Itraconazole solution 200 mg po or IV bid Template:OR Fluconazole 400 mg po q24h for 3–12 mo
• Locally severe or disseminated disease: Amphotericine B 0.6–1 mg/kg per day x 7 days then 0.8 mg/kg every other day or liposomal ampho B 3-5 mg/kg/d IV or ABLC 5 mg/kg/d IV, until clinical improvement (usually several wks or longer in disseminated disease), followed by itra or flu for at least 1 year.

Note (1) Some use combination of Ampho B & Flu for progressive severe disease; controlled series lacking.

Note (2) Consultation with specialist recommended: surgery may be required.

• Meningitis:

Adult:

• Preferred regimen: Fluconazole 400–1,000 mg po q24h indefinitely
• Alternative regimen: Ampho B IV as for pulmonary (above) + 0.1–0.3 mg daily intrathecal (intraventricular) via reservoir device. OR itra 400–800 mg q24h OR voriconazole

Some use combination of Ampho B & Flu for progressive severe disease; controlled series lacking.

• Child
• Preferred regimen: Fluconazole (po) (Pediatric dose not established, 6 mg per kg q24h used)
• Alternative regimen: Ampho B IV as for pulmonary (above) + 0.1–0.3 mg daily intrathecal (intraventricular) via reservoir device. OR itra 400–800 mg q24h OR voriconazole

==References==