6
Treatment
Management of Coccidioidomycosis in Patients Without
Overt Immunosuppressing Conditions
Health Education and Physical Therapy Reconditioning Programs
In the Management Program of Patients With Newly Diagnosed,
Uncomplicated Coccidioidal Pneumonia
Î Patients with uncomplicated pulmonary coccidioidomycosis should
have a management plan that incorporates regular medical follow-up,
health education, and a plan for physical reconditioning (S-L).
Î The IDSA recommends patient education, close observation, and
supportive measures such as reconditioning physical therapy for
patients who appear to have mild or nondebilitating symptoms, or who
have substantially improved or resolved their clinical illness by the time
of diagnosis (S-L).
Starting Antifungal Drug Therapy In Patients With Newly
Diagnosed, Uncomplicated Coccidioidal Pneumonia
Î The IDSA recommends initiating antifungal treatment for patients who,
at the time of diagnosis, have significantly debilitating illness (S-L).
Î For patients at the time of diagnosis with extensive pulmonary
involvement, with concurrent diabetes, or who are otherwise frail
because of age or comorbidities, the IDSA recommends initiating
antifungal treatment. Some experts would also include African or
Filipino ancestry as indications for treatment (S-L).
Î If treatment is begun in nonpregnant adults, the treatment should be
an orally absorbed azole antifungal (eg, fluconazole) at a daily dose of
≥400 mg (S-L).
Pulmonary Coccidioidomycosis With an Asymptomatic
Pulmonary Nodule and No Overt Immunosuppressing Conditions
Î Once there is confirmation that a pulmonary nodule is due to
coccidioidomycosis, the IDSA recommends no antifungal treatment for
an asymptomatic pulmonary nodule due to coccidioidomycosis (S-VL).
Asymptomatic Coccidioidal Cavity Without an
Immunosuppressing Condition
Î The IDSA recommends against the use of antifungal therapy for patients
with an asymptomatic cavity (S-L).
Symptomatic Chronic Cavitary Coccidioidal Pneumonia
Î The IDSA recommends that patients with symptomatic chronic
cavitary coccidioidal pneumonia be treated with an oral agent such as
fluconazole or itraconazole (S-M).
