From the Guidelines
Current treatment guidelines for valley fever (coccidioidomycosis) recommend a tailored approach based on disease severity, with fluconazole being the first-line medication for mild to moderate uncomplicated infections, and amphotericin B for severe or disseminated disease. For mild to moderate uncomplicated infections, observation without antifungal therapy is often sufficient as most immunocompetent patients recover spontaneously 1. When treatment is necessary, fluconazole is typically prescribed at 400-800 mg daily for 3-6 months, with alternative azoles including itraconazole (200 mg twice daily) being more effective for skeletal infections 1.
Key Considerations
- For severe or disseminated disease, amphotericin B (lipid formulation at 3-5 mg/kg/day) is recommended initially, followed by long-term azole therapy 1.
- Pregnant patients with severe disease should receive amphotericin B, as azoles are contraindicated during pregnancy.
- Treatment duration varies significantly: uncomplicated pneumonia may require 3-6 months, while disseminated disease often needs at least 12 months, and some patients with meningeal involvement require lifelong suppressive therapy.
- Surgical intervention may be necessary for complications like empyema or bone lesions.
Patient-Specific Recommendations
- For autologous or allogeneic HSCT or solid organ transplant recipients with acute or chronic pulmonary coccidioidomycosis who are clinically stable and have normal renal function, initiating treatment with fluconazole 400 mg daily or the equivalent dose based upon renal function is recommended 1.
- For patients with very severe and/or rapidly progressing acute pulmonary or disseminated coccidioidomycosis, the use of AmB until the patient has stabilized, followed by fluconazole is recommended 1.
Evidence-Based Practice
The recommendations are based on the 2016 Infectious Diseases Society of America (IDSA) clinical practice guideline for the treatment of coccidioidomycosis 1, which emphasizes a tailored approach to treatment based on disease severity and patient-specific factors.
From the Research
Current Treatment Guidelines for Valley Fever
The current treatment guidelines for valley fever, also known as coccidioidomycosis, are as follows:
- A majority of cases do not require specific treatment and will resolve on their own, so an approach with symptomatic treatment in mind is appropriate 2
- If symptoms do not resolve, azoles or amphotericin B may be used, with the standard drug of choice being fluconazole (Diflucan) 2, 3
- Treatment varies depending on the immunocompetency of the patient, with special considerations for pregnant patients and those with a history of human immunodeficiency virus (HIV) or transplantation 2, 4, 3
Treatment Options
The treatment options for valley fever include:
- Azoles, such as fluconazole, which is the most commonly prescribed antifungal agent for pulmonary coccidioidomycosis 3, 5
- Amphotericin B, which may be used to treat severe infections or complicated cases 2, 3, 5
- Other triazoles and amphotericin B products, which may be prescribed to treat nuanced aspects of coccidioidomycosis 3
Special Considerations
There are special considerations for certain populations, including:
- Pregnant patients, who require careful management due to the risk of disseminated disease 4, 3
- Patients with a history of human immunodeficiency virus (HIV) or transplantation, who are at higher risk of severe and disseminated disease 2, 4, 3
- Patients with impaired immunity, especially those with impaired cellular immunity, who are at higher risk of severe and disseminated disease 6