From the Guidelines
For valley fever (coccidioidomycosis), the recommended fluconazole dosage is 400 mg daily for adults with mild to moderate disease, as stated in the 2016 IDSA clinical practice guideline 1. This dosage is recommended for patients who are clinically stable and have normal renal function.
- The treatment duration usually ranges from 3-6 months for uncomplicated infections, but may extend to 12 months or longer for severe or disseminated disease.
- For patients with very severe and/or rapidly progressing acute pulmonary or disseminated coccidioidomycosis, AmB is recommended until the patient has stabilized, followed by fluconazole 1.
- It is essential to monitor liver function tests during treatment and inform the healthcare provider about other medications being taken to avoid potential interactions.
- The dosage may need to be adjusted based on renal function, and patients should take fluconazole at the same time each day with or without food, and complete the full course even if symptoms improve.
- Although other studies, such as the 2009 CDC guidelines 1, recommend similar dosages, the 2016 IDSA guideline 1 is the most recent and highest quality study, making its recommendations the most reliable.
From the Research
Fluconazole Dosage for Valley Fever
- The standard dosage of fluconazole for Valley Fever is not explicitly stated in the provided studies, but the dosage of 400 mg daily is mentioned in one study 2.
- This study, FLEET-Valley Fever, used fluconazole 400 mg daily for 42 days as early empiric treatment of coccidioidomycosis pneumonia (Valley Fever) in adults presenting with community-acquired pneumonia in endemic areas.
- Another study mentions that treatment may continue for as long as three to 12 months, although lifetime treatment is indicated for patients with coccidioidal meningitis 3.
- The dosage and duration of fluconazole treatment may vary depending on the immunocompetency of the patient and the severity of the disease 4.
Treatment Considerations
- Fluconazole is the standard drug of choice for treating Valley Fever, but treatment varies depending on the immunocompetency of the patient 4.
- Patients with compromised immune systems, such as those with HIV or undergoing transplantation, require special considerations 4.
- Pregnant patients should not be treated with fluconazole, and alternative treatments should be considered 3.