From the Guidelines
The recommended treatment for valley fever in a child typically involves observation alone for uncomplicated cases, as most children recover without antifungal treatment, but fluconazole may be considered for those with risk factors or severe symptoms. According to the 2016 Infectious Diseases Society of America (IDSA) clinical practice guideline for the treatment of coccidioidomycosis 1, expert practitioners have indicated good outcomes for the vast majority of patients with uncomplicated coccidioidal pneumonia who did not receive antifungal treatment.
When considering treatment, the following factors are important:
- The child's overall health and presence of any underlying conditions that may increase the risk of complications
- The severity of symptoms, with more severe cases potentially requiring antifungal therapy
- The potential benefits and risks of antifungal treatment, including the possibility of side effects and the lack of established optimal dose or duration of treatment
For children who do require antifungal treatment, fluconazole is often the preferred choice, with a typical dosage of 6-12 mg/kg/day (maximum 400-800 mg daily) for 3-6 months or longer, depending on the clinical response 1. However, it is essential to note that there is no strong evidence to support the use of antifungal treatment in uncomplicated cases, and the decision to treat should be made on a case-by-case basis, taking into account the individual child's needs and risk factors.
Regular follow-up appointments are crucial to monitor the child's response to treatment and adjust the treatment plan as needed. The goal of treatment is to control the fungal infection while the child's immune system develops its own response to the Coccidioides fungus, with the aim of minimizing morbidity, mortality, and improving quality of life.
From the Research
Valley Fever Treatment for Children
The treatment for valley fever in children depends on the severity of the disease and the child's immune status.
- For most children, valley fever will resolve on its own without specific treatment, and a symptomatic treatment approach is appropriate 2.
- If symptoms do not resolve, antifungal agents such as azoles or amphotericin B may be used, with fluconazole being the standard drug of choice 2, 3.
- The dosage of fluconazole for children varies depending on the age and weight of the child, with a recommended daily dosage of 6 mg/kg for children below 1 year of age 4.
- For children with severe fungal infections, fluconazole has been shown to be effective and well-tolerated, with a clinical cure or improvement achieved in 83% of cases 5.
- In cases where fluconazole is not effective or is contraindicated, other antifungal agents such as anidulafungin may be used, although more research is needed to determine the safety and efficacy of these agents in children 6.
Special Considerations
- Children with weakened immune systems, such as those with HIV or undergoing transplantation, may require special considerations and closer monitoring during treatment 2.
- Pregnant patients and those with a history of human immunodeficiency virus (HIV) or transplantation also require special considerations 2.
- The treatment duration for valley fever in children can vary from several months to a year or more, depending on the severity of the disease and the child's response to treatment 3.