From the Guidelines
For patients with uncomplicated coccidioidal pneumonia, no antifungal treatment is recommended, as the majority of patients recover without complication 1. When considering treatment for valley fever, it's essential to assess the severity of the infection.
- For mild cases, observation alone may be sufficient, as the infection often resolves on its own within weeks or months 1.
- However, for patients with concurrent diabetes or who are otherwise frail due to age or comorbidities, initiating antifungal treatment is recommended 1.
- Fluconazole is a commonly prescribed antifungal medication for valley fever, with a typical dosage of 400-800 mg daily for 3-6 months or longer, depending on the clinical response 1.
- Alternative antifungal medications, such as itraconazole, posaconazole, or voriconazole, may be considered in certain cases 1.
- It's crucial to monitor liver function tests regularly during treatment, as these medications can cause liver damage 1.
- Patients should complete the full course of medication, even if symptoms improve earlier, to prevent recurrence 1.
- Rest, adequate hydration, and over-the-counter pain relievers can help manage symptoms while the antifungals work to eliminate the infection.
From the FDA Drug Label
Amphotericin B for Injection USP is specifically intended to treat potentially life-threatening fungal infections: ... coccidioido-mycosis...
- Valley fever, also known as coccidioidomycosis, can be treated with amphotericin B (IV) in severe cases.
- The use of amphotericin B is reserved for progressive, potentially life-threatening fungal infections, including coccidioidomycosis 2.
From the Research
Treatment Options for Valley Fever
- The treatment for valley fever, also known as coccidioidomycosis, varies depending on the severity of the disease and the patient's immunocompetency 3, 4, 5.
- In most cases, valley fever does not require specific treatment and will resolve on its own, so an approach with symptomatic treatment in mind is appropriate 3.
- Antifungal agents such as azoles or amphotericin B may be used if symptoms do not resolve, with fluconazole being the standard drug of choice 3, 4, 5.
- Treatment may continue for as long as three to 12 months, although lifetime treatment is indicated for patients with coccidioidal meningitis 4.
- Monitoring of complement fixation titers and chest radiography is recommended until patients stabilize and symptoms resolve 4.
Special Considerations
- Pregnant patients and those with a history of human immunodeficiency virus (HIV) or transplantation require special considerations when treating valley fever 3, 5, 6.
- Individuals with suppressed cellular immunity, such as those with HIV infection or those on immunosuppressive medications, are at increased risk for symptomatic coccidioidomycosis 5.
- African-American men and pregnant women have been identified as two other groups who are at an increased risk for symptomatic and severe infection 5.