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Preemptive Strategies for Coccidioidomycosis in Special
At-Risk Populations
Î For all patients undergoing organ transplantation in the endemic area
without active coccidioidomycosis, the IDSA recommends the use of an
oral azole (eg, fluconazole 200 mg) for 6–12 months (S-L).
Î For patients in the endemic area, the IDSA recommends screening
with Coccidioides serology prior to initiation of biologic response
modifier therapy, as well as regular clinical followup for new signs and
symptoms (S-VL).
• The IDSA does NOT recommend regular serologic screening or antifungal
prophylaxis in asymptomatic patients taking biologic response modifiers (BRMs)
(S-VL).
Table 1. Recommended Drugs
Drug Dose Comments
Amphotericin B 0.5–1.0 mg/kg/day IV BOXED WARNING:
• This drug should be used primarily for
treatment of patients with progressive
and potentially life-threatening fungal
infections.
• EXERCISE CAUTION to prevent
inadvertent overdosage, which may
result in potentially fatal cardiac or
cardiopulmonary arrest.
Fluconazole Prophylaxis:
• 200 mg daily
Low:
• 400 mg daily
• 6–12 mg/kg daily
High:
• 800–1200 mg daily
Not FDA-approved for
coccidioidomycosis
Itraconazole 200 mg every 12 hours BOXED WARNING:
• Not FDA-approved for
coccidioidomycosis
• Congestive heart failure, cardiac effects
and drug interactions
Posaconazole 400 mg orally every
12 hours
Not FDA-approved for
coccidioidomycosis
Voriconazole 200 mg or 4 mg/kg
every 12 hours
• Not FDA-approved for
coccidioidomycosis
• No food 1 hour pre- and post-dose
Treatment
