Materiały źródłowe

• #1 Valley fever | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/valley-fever?content_id=CON-20378744

  Valley fever usually involves supportive care and sometimes medications. […] If symptoms don’t improve, last a long time or become worse, or you’re at increased risk of complications, your doctor may prescribe an antifungal medication, such as fluconazole. Antifungal medications are also used for people with chronic or disseminated disease. […] The antifungal drugs fluconazole (Diflucan) or itraconazole (Sporanox, Tolsura) are generally used for all but the most serious forms of coccidioidomycosis disease. […] More serious infection may first be treated with an intravenous antifungal medication such as amphotericin B (Abelcet, Ambisome, others). […] Three newer medications voriconazole (Vfend), posaconazole (Noxafil) isavuconazonium sulfate (Cresemba) may also be used to treat more-serious infections.

• #1 Treatment of Valley Fever | Valley Fever | CDC

  https://www.cdc.gov/valley-fever/treatment/index.html

  Most infections go away on their own without any medication. […] People with severe infections are treated with antifungal medications. […] Healthcare providers may prescribe 3-6 months of oral antifungal medication like fluconazole. This is for people with more serious infections or people with risk factors for severe infections. […] People who have severe lung infections or infections that have spread to other parts of the body need antifungal treatment. […] Valley fever that develops into meningitis is fatal if its not treated, so lifelong antifungal treatment is necessary for those cases. […] Treatment of severe valley fever can take longer than six months.

• #1 IDSA 2016 Clinical Practice Guideline for the Treatment of Coccidioidomycosis

  https://www.idsociety.org/practice-guideline/coccidioidomycosis/

  We recommend initiating antifungal treatment for patients who, at the time of diagnosis, have significantly debilitating illness (strong, low). […] For patients at the time of diagnosis with extensive pulmonary involvement, with concurrent diabetes, or who are otherwise frail because of age or comorbidities, we recommend initiating antifungal treatment. Some experts would also include African or Filipino ancestry as indications for treatment (strong, low). […] If treatment is begun in nonpregnant adults, the treatment should be an orally absorbed azole antifungal (eg, fluconazole) at a daily dose of 400 mg (strong, low). […] We recommend against the use of antifungal therapy for patients with an asymptomatic cavity (strong, low). […] We recommend that patients with symptomatic chronic cavitary coccidioidal pneumonia be treated with an oral agent such as fluconazole or itraconazole (strong, moderate).

• #1 Treating and Managing Coccidioidomycosis | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/coccidioidomycosis/treating-and-managing

  Most individuals with coccidioidomycosis do not require specific treatment. Treatment with antifungal medications may be prescribed for those with more severe symptoms or symptoms lasting eight weeks or longer. […] Treatment typically lasts for several months, and the length will vary depending on how well your body responds. More severe cases may require hospitalization and intravenous (IV) antifungal medication. In patients with depressed immune systems or with disease outside the lung (disseminated), lifelong treatment may be required. In very few individuals, surgery may be required to remove portions of infected or damaged lung. […] If your condition is more severe, you should stay in touch with your doctor and receive follow-up blood testing and lung imaging, such as chest X-rays or CT scans, for at least the first year. This will ensure that if you do develop chronic or disseminate infections, they are caught and treated immediately. If your doctor thinks you need additional medical attention, they may refer you to a pulmonary or infectious disease specialist, although this is less likely to happen in regions where the primary care provider is familiar with the disease.

• #1 IDSA 2016 Clinical Practice Guideline for the Treatment of Coccidioidomycosis

  https://www.idsociety.org/practice-guideline/coccidioidomycosis/

  For the treatment of patients with very severe and/or rapidly progressing acute pulmonary or disseminated coccidioidomycosis, we recommend the use of AmB until the patient has stabilized, followed by fluconazole (strong, low). […] The development of symptomatic coccidioidomycosis during pregnancy should prompt consideration of starting administration of antifungal therapy (strong, moderate). […] For women who develop initial nonmeningeal coccidioidal infection during their first trimester of pregnancy, intravenous AmB is recommended (strong, moderate). […] Antifungal therapy is recommended for all patients with HIV infection with clinical evidence of coccidioidomycosis and a peripheral blood CD4+ T-lymphocyte count 250 cells/L (strong, moderate).

• #1 Coccidioidomycosis and Valley Fever Treatment & Management: Approach Considerations, Antifungal Medications, Investigational Agents

  https://emedicine.medscape.com/article/215978-treatment

  Individuals with chronic progressive fibrocavitary pneumonia should immediately start antifungal treatment with an oral azole and continue therapy for at least 1 year. […] All patients with disseminated coccidioidomycosis warrant prolonged antifungal treatment. […] The treatment of septic shock associated with coccidioidomycosis relies on the use of antifungal therapy and appropriate resuscitative and supportive measures. […] Fluconazole can be used in the treatment of mild to moderate meningitis and, occasionally, life-threatening meningitis in patients who opt against amphotericin B or who have contraindications to its use. […] The usual dosage of fluconazole is 400 mg/day, but many physicians start with 800 or 1000 mg/day. […] Treatment of active disease is the same as in other patients; however, if the CD4+ cell count is less than 250/L, antifungal therapy should continue until the count recovers to above 250 cells/L. Indefinitely continue suppressive therapy after active disease (ie, secondary prophylaxis) with oral itraconazole (200 mg twice a day) or fluconazole (400 mg each day), regardless of the CD4+ cell count.

• #1 IDSA 2016 Clinical Practice Guideline for the Treatment of Coccidioidomycosis

  https://www.idsociety.org/practice-guideline/coccidioidomycosis/

  For severe osseous disease, we recommend AmB as initial therapy, with eventual change to azole therapy for the long term (strong, low). […] For CM, we recommend fluconazole 400-1200 mg orally daily as initial therapy for most patients with normal renal function (strong, moderate). […] For CM, we recommend azole treatment for life (strong, moderate). […] In patients who clinically fail initial therapy with fluconazole, higher doses are a first option (strong, moderate). Alternative options are to change therapy to another orally administered azole, or to initiate intrathecal AmB therapy. […] For the treatment of autologous or allogeneic HSCT or solid organ transplant recipients with acute or chronic pulmonary coccidioidomycosis who are clinically stable and have normal renal function, we recommend initiating treatment with fluconazole 400 mg daily or the equivalent dose based upon renal function (strong, low).

• #1 IDSA 2016 Clinical Practice Guideline for the Treatment of Coccidioidomycosis

  https://www.idsociety.org/practice-guideline/coccidioidomycosis/

  We recommend that surgical options be explored when the cavities are persistently symptomatic despite antifungal treatment. We recommend that surgical options be considered when cavities have been present for more than 2 years and if symptoms recur whenever antifungal treatment is stopped (strong, very low). […] For patients with ruptured coccidioidal cavities, oral azole therapy is recommended. For patients who do not tolerate oral azole therapy or patients whose disease requires 2 or more surgical procedures for control, intravenous AmB is recommended (strong, very low). […] We recommend antifungal therapy in all cases of extrapulmonary soft tissue coccidioidomycosis (strong, moderate). […] We recommend azole therapy for bone and joint coccidioidomycosis, unless the patient has extensive or limb-threatening skeletal or vertebral disease causing imminent cord compromise (strong, low).

• #1 Valley Fever: Pathogenesis and Evolving Treatment Options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10774831/

  Most cases of coccidioidomycosis do not require treatment or can simply be resolved via symptomatic treatment. These symptomatic treatments can include nonsteroidal anti-inflammatory drugs (NSAIDs) as well as rest. If symptoms do not subside, there are two classes of drugs generally used for treatment: azoles and amphotericin B. Azoles work by inhibiting the synthesis of ergosterol in the cell membrane. The current preferred drug to treat coccidioidomycosis is fluconazole (Diflucan, Pfizer, New York, New York, United States). The recommended dosage of fluconazole is between 400 mg and 1200 mg daily. A second medication that is used for the treatment of coccidioidomycosis is amphotericin B. This drug is the drug of choice in severe or refractory cases of coccidioidomycosis. Recent studies show that corticosteroids can be used to hasten recovery from a coccidioidomycosis infection. Treatment of immunocompromised hosts living in an endemic area may differ from that of immunocompetent hosts. For patients with HIV infection, all patients receive an antifungal therapy consisting of either fluconazole or itraconazole. In the case of transplant recipients, all patients that live in an endemic area should be screened prior to transplantation. Lastly, special considerations must be taken for pregnant patients. Women that acquire coccidioidomycosis during their second or third trimester should take a triazole such as fluconazole as treatment.

• #1 Valley Fever Solutions

  https://valleyfeversolutions.com/

  Better treatment is needed for Valley Fever. Its ready for final development. […] Its time.

• #2 Treatment of Valley Fever | Valley Fever | CDC

  https://www.cdc.gov/valley-fever/treatment/index.html

  Most infections go away on their own without any medication. […] People with severe infections are treated with antifungal medications. […] Healthcare providers may prescribe 3-6 months of oral antifungal medication like fluconazole. This is for people with more serious infections or people with risk factors for severe infections. […] People who have severe lung infections or infections that have spread to other parts of the body need antifungal treatment. […] Valley fever that develops into meningitis is fatal if its not treated, so lifelong antifungal treatment is necessary for those cases. […] Treatment of severe valley fever can take longer than six months.

• #2 Valley Fever: Symptoms, Causes, Diagnosis, Treatment

  https://www.webmd.com/a-to-z-guides/valley-fever

  Valley fever usually doesn’t need medical treatment. For people who are otherwise healthy, bed rest and drinking plenty of fluids are enough. Your doctor will keep a close watch on how you’re doing. […] If the symptoms hang on, get worse, or the infection spreads, your doctor might prescribe a drug that attacks illnesses caused by fungus. You may have to take the drug for three to six months. There are several options depending on how severe the symptoms are. […] Some medicines your doctor may recommend include Amphotericin B (Amphocin), Fluconazole (Diflucan), Isavuconazonium sulfate (Cresemba), Itraconazole (Tolsura), Posaconazole (Noxafil), Voriconazole (Vfend). […] In the most extreme cases, such as in people who develop meningitis, lifelong medication may be necessary.

• #2

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4711193/

  Therapy of coccidioidomycosis continues to evolve. For primary pulmonary disease, antifungal therapy is frequently not required while prolonged courses of antifungals are generally needed for those in whom extrathoracic disseminated has occurred. Intravenous amphotericin B should be reserved for those with severe disease. Oral triazole antifungals have had a great impact on the management of coccidioidomycosis. Both fluconazole and itraconazole at 400 mg daily have been effective for various forms of coccidioidomycosis, including meningitis, although relapse after therapy is discontinued is a problem. […] It is clear that most patients with primary coccidioidal pneumonia who are immunocompetent will resolve their clinical illness without the use of antifungal therapy. […] Based on these observations and studies, it is clear that the decision to treat primary pulmonary coccidioidomycosis is not automatic and should be individualized. Patients with severe disease, including those requiring hospitalization, those with symptoms persisting for more than six weeks, and those with underlying cellular immune deficiencies, are candidates for antifungal therapy.

• #2 Coccidioidomycosis and Valley Fever Treatment & Management: Approach Considerations, Antifungal Medications, Investigational Agents

  https://emedicine.medscape.com/article/215978-treatment

  If the option to treat is chosen, several medications are available for management. Amphotericin B, introduced in 1957, remains the treatment of choice for severe infections. […] The introduction of azoles revolutionized therapy for coccidioidomycosis, and these agents are usually the first line of therapy. […] Typical antifungal therapy of acute primary pulmonary coccidioidomycosis in these high-risk groups consists mainly of oral azoles at the recommended adult doses. […] Antifungal therapy for asymptomatic pulmonary nodules is not typically recommended in immunocompetent patients. […] Initially, treat patients with diffuse pulmonary disease (ie, miliary or reticulonodular infiltrates) with amphotericin B or high-dose fluconazole for several weeks until definite signs of improvement are observed.

• #2 Antifungal Therapy | UC Davis Center for Valley Fever

  https://health.ucdavis.edu/valley-fever/about-valley-fever/treatment-antifungal-therapy/index.html

  Voriconazole and posaconazole are newer triazoles and primarily are used in patients whose coccidioidal infection is refractory to first-line azole therapy. […] Isavuconazole is a newly available extended-spectrum triazole with in vitro activity against Coccidioides spp. […] The echinocandins have little inherent activity against Coccidioides spp. in the mycelial phase, however potential efficacy has been demonstrated in murine models of infection.

• #2 Treating and Managing Coccidioidomycosis | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/coccidioidomycosis/treating-and-managing

  Most individuals with coccidioidomycosis do not require specific treatment. Treatment with antifungal medications may be prescribed for those with more severe symptoms or symptoms lasting eight weeks or longer. […] Treatment typically lasts for several months, and the length will vary depending on how well your body responds. More severe cases may require hospitalization and intravenous (IV) antifungal medication. In patients with depressed immune systems or with disease outside the lung (disseminated), lifelong treatment may be required. In very few individuals, surgery may be required to remove portions of infected or damaged lung. […] If your condition is more severe, you should stay in touch with your doctor and receive follow-up blood testing and lung imaging, such as chest X-rays or CT scans, for at least the first year. This will ensure that if you do develop chronic or disseminate infections, they are caught and treated immediately. If your doctor thinks you need additional medical attention, they may refer you to a pulmonary or infectious disease specialist, although this is less likely to happen in regions where the primary care provider is familiar with the disease.

• #2 FAQs | Valley Fever Center For Excellence

  https://vfce.arizona.edu/valley-fever-people/faqs

  What is the length of treatment for Valley fever? The length of treatment depends on the severity of symptoms and disease and complications of the disease. Some patients take antifungal medication for a few months; others need life time therapy. […] Why won’t my doctor prescribe any medication when I feel really sick? Before the availability of antifungal medications, at least 95% of patients with pulmonary Valley fever got better without any treatment. Studies have not been completed yet to determine if drug therapy hastens the resolution of immediate symptoms or prevents subsequent complications. The physician usually monitors the progress of the patient by chest x-rays, following the cocci serology (blood test) titer and the severity and duration of symptoms. This may require frequent visits to the doctor. If weight loss and night sweats continue, infiltrates in the lungs enlarge, and the inability to work persists, antifungal medication usually is considered.

• #2

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4711193/

  A case report study indicated a relapse rate of 78% when therapy was discontinued, leading to the recommendation that triazole therapy for coccidioidal meningitis should be life-long. […] There is a role for surgical therapy in coccidioidomycosis. […] Because the cellular immune response is critical to control of coccidioidomycosis, patients with such an immune deficiency require special consideration. Most experts would recommend antifungal therapy for all types of coccidioidomycosis, including primary pulmonary disease, in such patients. […] For those with severe disease requiring hospitalization, initial therapy with amphotericin B combined with a triazole antifungal is recommended. […] The use of azole antifungals during pregnancy has been controversial.

• #2 Coccidioidomycosis: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/coccidioidomycosis

  Yearly or twice-yearly serological testing for coccidioidomycosis should be considered for serologically negative individuals with HIV who live in endemic areas (BIII). […] Primary antifungal prophylaxis or pre-emptive therapy is not recommended for individuals with HIV and low CD4 counts who live in endemic areas and who have negative serologic tests for Coccidioides (AIII). […] Preferred Therapy: Fluconazole 400 mg PO once daily (AIII). […] Indications for Treatment: Clinically mild infection, such as focal pneumonia. […] Preferred Therapy: Fluconazole 400 mg PO once daily (AII), or Itraconazole 200 mg PO three times daily for 3 days then twice daily (AII). […] Alternative Therapy (For Patients Who Failed to Respond to Fluconazole or Itraconazole): Voriconazole loading dose of 400 mg PO twice daily on Day 1, followed by 200 mg PO twice daily (BIII), or Posaconazole delayed-release tablet 300 mg PO twice daily on Day 1, followed by 300 mg once daily (BIII), or Isavuconazole sulfate 372 mg (isavuconazole 200 mg) PO every 8 hours for six doses, followed by isavuconazole sulfate 372 mg (isavuconazole 200 mg) PO once daily (BIII).

• #2 Valley Fever Causes, Symptoms, Diagnosis, Treatment

  https://www.medicinenet.com/valley_fever/article.htm

  What is the treatment for valley fever? […] The majority of cases (over 60%) spontaneously resolves and requires no treatment. However, there are several anti-fungal drugs available to treat coccidioidomycosis if needed. The drug of choice is usually amphotericin B, but oral azoles (fluconazole [Diflucan], itraconazole [Sporanox], and ketoconazole [Nizoral]). Newer antifungal agents including posaconazole and voriconazole are often used „off label,” meaning they have not been approved to treat coccidioidomycosis. Most of these drugs have side effects, and most have not been proven safe to use in pregnant patients except for amphotericin B. […] Sometimes a patient may need surgical treatment. Pulmonary cavities, persistent pulmonary infection, empyema (pus collection), and shunt placement are some of the surgical interventions used to treat this disease. […] Other treatments (for example, prednisone [Deltasone, Liquid Pred] or alternative therapy such as dietary modification) are not currently recommended by most physicians; people should consult with their physician before trying to use such methods.

• #2 Understanding and Managing Valley Fever | Banner Health

  https://www.bannerhealth.com/services/infectious-disease/treatment/valley-fever

  Along with medication, your health care provider may recommend treatments to help reduce your symptoms: OTC pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil) may help with muscle aches, joint pain and fever. […] Cough suppressants or expectorants can help reduce coughing and irritation. […] Rest and fluids can help support your bodys immune system so you can recover. […] Physical therapy and reconditioning may help with fatigue and muscle aches as you recover. […] If you have Valley fever and your symptoms are getting worse or you have new health concerns, contact your health care provider. Youll also need regular follow-up appointments with your provider to monitor your treatment progress.

• #2 A near-fatal Valley Fever case opens doors to new treatment method | UCLA

  https://newsroom.ucla.edu/stories/a-near-fatal-valley-fever-case-opens-doors-to-new-treatment-method

  Of the 8,000 Californians who will contract Valley Fever this year, most will recover without treatment, and those with more serious cases will require an antifungal medication that clears the infection. […] Now, an experimental treatment used by physicians at UCLA Mattel Childrens Hospital that cured a 4-year-old boy may provide an explanation and a method for manipulating the immune system to combat not just Valley Fever, but a host of infections. […] To help Abrahams immune system clear the infection, the UCLA team administered a powerful combination of antifungal medications. […] The team treated Abraham with multiple injections of interferon gamma to supplement the deficiency and boost his immune system. […] Garcia-Lloret proposed that the drug dupilumab approved by the U.S. Food and Drug Administration in March to treat eczema and in October to treat asthma might help reprogram Abrahams immune system and run type 1 immunity instead.

• #2 Coccidioidomycosis and Valley Fever Treatment & Management: Approach Considerations, Antifungal Medications, Investigational Agents

  https://emedicine.medscape.com/article/215978-treatment

  Most patients infected with Coccidioides are asymptomatic or have self-limited symptoms and require only supportive care. Symptomatic patients usually come to medical attention because of respiratory tract or systemic manifestations. Management in symptomatic patients varies with the clinical syndrome. […] Because most Coccidioides infections resolve without specific therapy, few clinical trials have assessed outcomes in less-severe disease. Most treatment recommendations represent consensus guidelines based on the Mycosis Study Group trials and the experience of many investigators. […] However, the Infectious Diseases Society of America has published Practice Guidelines for the Treatment of Coccidioidomycosis. […] The objectives of treatment are resolution of infection, decrease of antibody titers, return of function of involved organs, and prevention of relapse.

• #3 Coccidioidomycosis and Valley Fever Treatment & Management: Approach Considerations, Antifungal Medications, Investigational Agents

  https://emedicine.medscape.com/article/215978-treatment

  Most patients infected with Coccidioides are asymptomatic or have self-limited symptoms and require only supportive care. Symptomatic patients usually come to medical attention because of respiratory tract or systemic manifestations. Management in symptomatic patients varies with the clinical syndrome. […] Because most Coccidioides infections resolve without specific therapy, few clinical trials have assessed outcomes in less-severe disease. Most treatment recommendations represent consensus guidelines based on the Mycosis Study Group trials and the experience of many investigators. […] However, the Infectious Diseases Society of America has published Practice Guidelines for the Treatment of Coccidioidomycosis. […] The objectives of treatment are resolution of infection, decrease of antibody titers, return of function of involved organs, and prevention of relapse.

• #3 TREATMENTS FOR COCCIDIOIDOMYCOSIS – Mycology Advocacy, Research & Education (MyCARE)

  https://fightfungus.org/treatments-for-coccidioidomycosis/

  For mild pulmonary symptoms, you may not need antifungal treatment at all. […] The decision to treat is often based on the patients symptoms and the doctors past experience treating the disease. […] It is important that patients understand that there are different perspectives on treatment and ensure that healthcare providers listen to their concerns. […] Then who should receive treatment? This should be individualized with your healthcare provider, but some of the groups for whom antifungal treatment should be used include: Patients with severe disease (including hospitalized patients), Those with symptoms persisting for six weeks, Those with underlying cellular immune deficiencies, Those who are on certain types of medications that suppress the immune system, People with diabetes or who are frail because of age or comorbidities, People at high risk for dissemination including people of African or Filipino ancestry.

• #3 Valley Fever: Pathogenesis and Evolving Treatment Options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10774831/

  Most cases of coccidioidomycosis do not require treatment or can simply be resolved via symptomatic treatment. These symptomatic treatments can include nonsteroidal anti-inflammatory drugs (NSAIDs) as well as rest. If symptoms do not subside, there are two classes of drugs generally used for treatment: azoles and amphotericin B. Azoles work by inhibiting the synthesis of ergosterol in the cell membrane. The current preferred drug to treat coccidioidomycosis is fluconazole (Diflucan, Pfizer, New York, New York, United States). The recommended dosage of fluconazole is between 400 mg and 1200 mg daily. A second medication that is used for the treatment of coccidioidomycosis is amphotericin B. This drug is the drug of choice in severe or refractory cases of coccidioidomycosis. Recent studies show that corticosteroids can be used to hasten recovery from a coccidioidomycosis infection. Treatment of immunocompromised hosts living in an endemic area may differ from that of immunocompetent hosts. For patients with HIV infection, all patients receive an antifungal therapy consisting of either fluconazole or itraconazole. In the case of transplant recipients, all patients that live in an endemic area should be screened prior to transplantation. Lastly, special considerations must be taken for pregnant patients. Women that acquire coccidioidomycosis during their second or third trimester should take a triazole such as fluconazole as treatment.

• #3 Coccidioidomycosis: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/coccidioidomycosis

  Yearly or twice-yearly serological testing for coccidioidomycosis should be considered for serologically negative individuals with HIV who live in endemic areas (BIII). […] Primary antifungal prophylaxis or pre-emptive therapy is not recommended for individuals with HIV and low CD4 counts who live in endemic areas and who have negative serologic tests for Coccidioides (AIII). […] Preferred Therapy: Fluconazole 400 mg PO once daily (AIII). […] Indications for Treatment: Clinically mild infection, such as focal pneumonia. […] Preferred Therapy: Fluconazole 400 mg PO once daily (AII), or Itraconazole 200 mg PO three times daily for 3 days then twice daily (AII). […] Alternative Therapy (For Patients Who Failed to Respond to Fluconazole or Itraconazole): Voriconazole loading dose of 400 mg PO twice daily on Day 1, followed by 200 mg PO twice daily (BIII), or Posaconazole delayed-release tablet 300 mg PO twice daily on Day 1, followed by 300 mg once daily (BIII), or Isavuconazole sulfate 372 mg (isavuconazole 200 mg) PO every 8 hours for six doses, followed by isavuconazole sulfate 372 mg (isavuconazole 200 mg) PO once daily (BIII).

• #3 IDSA 2016 Clinical Practice Guideline for the Treatment of Coccidioidomycosis

  https://www.idsociety.org/practice-guideline/coccidioidomycosis/

  For severe osseous disease, we recommend AmB as initial therapy, with eventual change to azole therapy for the long term (strong, low). […] For CM, we recommend fluconazole 400-1200 mg orally daily as initial therapy for most patients with normal renal function (strong, moderate). […] For CM, we recommend azole treatment for life (strong, moderate). […] In patients who clinically fail initial therapy with fluconazole, higher doses are a first option (strong, moderate). Alternative options are to change therapy to another orally administered azole, or to initiate intrathecal AmB therapy. […] For the treatment of autologous or allogeneic HSCT or solid organ transplant recipients with acute or chronic pulmonary coccidioidomycosis who are clinically stable and have normal renal function, we recommend initiating treatment with fluconazole 400 mg daily or the equivalent dose based upon renal function (strong, low).

• #3 Treatment of Valley Fever | Valley Fever | CDC

  https://www.cdc.gov/valley-fever/treatment/index.html

  Most infections go away on their own without any medication. […] People with severe infections are treated with antifungal medications. […] Healthcare providers may prescribe 3-6 months of oral antifungal medication like fluconazole. This is for people with more serious infections or people with risk factors for severe infections. […] People who have severe lung infections or infections that have spread to other parts of the body need antifungal treatment. […] Valley fever that develops into meningitis is fatal if its not treated, so lifelong antifungal treatment is necessary for those cases. […] Treatment of severe valley fever can take longer than six months.

• #3 Coccidioidomycosis and Valley Fever Treatment & Management: Approach Considerations, Antifungal Medications, Investigational Agents

  https://emedicine.medscape.com/article/215978-treatment

  Individuals with chronic progressive fibrocavitary pneumonia should immediately start antifungal treatment with an oral azole and continue therapy for at least 1 year. […] All patients with disseminated coccidioidomycosis warrant prolonged antifungal treatment. […] The treatment of septic shock associated with coccidioidomycosis relies on the use of antifungal therapy and appropriate resuscitative and supportive measures. […] Fluconazole can be used in the treatment of mild to moderate meningitis and, occasionally, life-threatening meningitis in patients who opt against amphotericin B or who have contraindications to its use. […] The usual dosage of fluconazole is 400 mg/day, but many physicians start with 800 or 1000 mg/day. […] Treatment of active disease is the same as in other patients; however, if the CD4+ cell count is less than 250/L, antifungal therapy should continue until the count recovers to above 250 cells/L. Indefinitely continue suppressive therapy after active disease (ie, secondary prophylaxis) with oral itraconazole (200 mg twice a day) or fluconazole (400 mg each day), regardless of the CD4+ cell count.

• #3

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4711193/

  When antifungal therapy is prescribed, the preferred treatment is an oral triazole with fluconazole favored over itraconazole. […] While the primary pneumonia of coccidioidomycosis is an alveolar infiltrate, over time it consolidates, resulting in a pulmonary nodule. […] Occasionally, a pulmonary nodule excavates its contents into the bronchial tree, resulting in a cavity. […] In such cases, a course of an oral azole triazole antifungal, such as fluconazole or itraconazole, at 400 mg daily can ameliorate such symptoms. […] Chronic pulmonary coccidioidomycosis consists of pulmonary infiltrates, particularly in the apical or subapical regions, with symptoms persisting for months that include cough, weight loss, hemoptysis, chest pain, and dyspnea. […] Initial therapy should begin with amphotericin B.

• #3 FAQs | Valley Fever Center For Excellence

  https://vfce.arizona.edu/valley-fever-people/faqs

  What kinds of doctors know most about Valley fever? Infectious disease specialists can treat patients with a diagnosed case of Valley fever. In endemic areas, pulmonary specialists and most primary care and family practitioners should be versed in the diagnosis and treatment of this disease. However, physicians in other parts of the country treat patients with Valley fever much less frequently and, therefore, may not consider it as a diagnosis. Be sure to tell your physician that you have been in the endemic area and request to be tested for Valley fever.

• #3 Coccidioidomycosis (Valley fever) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/coccidioidomycosis-valley-fever/

  If itraconazole is selected, serum levels should be measured to document adequate absorption. For uncomplicated pulmonary infections, treatment is typically continued for 3 to 6 months. Disseminated infections involving the skin are treated for at least 6 to 12 months. […] As the infection wanes, the complement fixation titers are expected to decrease and may be become undetectable. However, relapsed infections are common when antifungal therapy is discontinued. Lifelong azole therapy is needed in some cases. […] In addition to antifungal therapy, some patients may benefit from symptomatic treatment of cutaneous manifestations. […] For painful lesions of erythema nodosum or Sweets syndrome, over-the counter acetaminophen or ibuprofen may be used as directed. […] In disseminated coccidioidomycosis, the skin occasionally serves as a sanctuary site for disseminated organisms. Even after the pulmonary infection has resolved, localized cutaneous plaques and nodules containing coccidioidal spherules, may persist for months or many years. In such cases, excisional cutaneous surgery may be helpful in removing the persistent nidus of infection. Concurrent treatment with systemic antifungal medications is recommended.

• #3 A near-fatal Valley Fever case opens doors to new treatment method | UCLA

  https://newsroom.ucla.edu/stories/a-near-fatal-valley-fever-case-opens-doors-to-new-treatment-method

  Lab experiments using Abraham’s cells demonstrated that dupilumab showed promise in pushing his cells toward the infection-busting type 1 pathway, so Butte and Garcia-Lloret administered treatments of the drug in addition to injections of interferon gamma for Abraham. […] Butte suspects that the method used to block an immune program to fight infection could potentially be used to help other people with severe forms of Valley Fever. […] Whenever we see a child like Abraham, who has a severe infection, our team at UCLA uses advanced testing to look for rare, genetic immune deficiency diseases that underlie the failure to adequately fight infections, Butte said. […] A group Butte is leading, across three University of California campuses and the Kern Medical Valley Fever Institute, was just awarded $650,000 by UC Research Initiatives to investigate Valley Fever.

• #3 Coccidioidomycosis (Valley fever) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/coccidioidomycosis-valley-fever/

  Treatment options are summarized in Table II and Table III. […] Multiple factors must be considered in deciding upon therapy for coccidioidomycosis. Therapeutic decisions are usually based upon the severity of the pulmonary infection, the risk factors of the host, and the possible presence of dissemination. […] Treatment of uncomplicated coccidioidal pneumonia is controversial. In many cases, patients are simply followed without antifungal treatment, and the infection usually resolves spontaneously over a period of weeks or months. […] Complicated or persistent pneumonia and all disseminated infections do require therapeutic intervention in all cases. Patients with risk factors for severe infection also require therapy. […] For most patients with disseminated cutaneous lesions, fluconazole is considered the treatment of choice. Fluconazole has good bioavailability and penetrates cutaneous adnexa in high concentrations.

• #4 Valley Fever Causes, Symptoms, Diagnosis, Treatment

  https://www.medicinenet.com/valley_fever/article.htm

  What is the treatment for valley fever? […] The majority of cases (over 60%) spontaneously resolves and requires no treatment. However, there are several anti-fungal drugs available to treat coccidioidomycosis if needed. The drug of choice is usually amphotericin B, but oral azoles (fluconazole [Diflucan], itraconazole [Sporanox], and ketoconazole [Nizoral]). Newer antifungal agents including posaconazole and voriconazole are often used „off label,” meaning they have not been approved to treat coccidioidomycosis. Most of these drugs have side effects, and most have not been proven safe to use in pregnant patients except for amphotericin B. […] Sometimes a patient may need surgical treatment. Pulmonary cavities, persistent pulmonary infection, empyema (pus collection), and shunt placement are some of the surgical interventions used to treat this disease. […] Other treatments (for example, prednisone [Deltasone, Liquid Pred] or alternative therapy such as dietary modification) are not currently recommended by most physicians; people should consult with their physician before trying to use such methods.

• #4 Valley Fever: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17754-valley-fever

  Treatment for Valley fever will depend on how severe your condition is and how your provider wants to manage it. They might recommend keeping an eye on your symptoms before prescribing medications, or they might treat you to reduce the risk of serious illness. If you have a serious or ongoing infection or if you have risk factors for severe illness (like chronic pulmonary disease) they may prescribe antifungal medications. […] If you need treatment for Valley fever, your healthcare provider may prescribe one of these medications: Fluconazole. Itraconazole. Amphotericin B (AmB). […] Your healthcare provider may prescribe antifungal treatments for Valley fever for three to six months. Your treatment may last longer depending on your case.

• #4 Antifungal Therapy | UC Davis Center for Valley Fever

  https://health.ucdavis.edu/valley-fever/about-valley-fever/treatment-antifungal-therapy/index.html

  In severe or refractory coccidioidal disease, an intravenous amphotericin B formulation is considered the drug of choice. […] The introduction of azoles was a significant breakthrough in the treatment of coccidioidomycosis for both meningeal and non-meningeal disease. […] Fluconazole was the next to be developed, and it still remains the preferred triazole due to its excellent bioavailability, tolerability, CNS penetration, slow clearance (24-30 hour half-life), little hepatotoxicity, renal clearance, no endocrine side effects, reasonable response rates in prior reports, and generally lower costs. […] The disadvantage of azole therapy is the inability to eradicate the fungus, which seems to be a class effect, thus treatment is continued indefinitely as a suppressive rather than curative therapy for CM although newer formulations and agents may offer mean fungicidal concentrations achievable in clinical care.

• #4 Understanding and Managing Valley Fever | Banner Health

  https://www.bannerhealth.com/services/infectious-disease/treatment/valley-fever

  Most of the time, you dont need treatment for Valley fever. Your immune system will help you heal, although it may take a few weeks to a few months. […] If you need treatment, your health care provider may prescribe antifungal medications that fight the infection. Which medication you take and how long youll need treatment will depend on how severe the infection is and your overall health. […] Medications that are usually prescribed include: Azoles: Medications such as fluconazole (Diflucan) and itraconazole (Sporanox, Tolsura), can treat mild to moderate cases of Valley fever. Voriconazole (Vfend), posaconazole (Noxafil) and isavuconazonium sulfate (Cresemba) may be used for more serious infections. They may stop the fungus from growing and spreading. […] Amphotericin B (Abelcet, Ambisome): This medication treats more severe cases of Valley fever or cases that have spread to other parts of the body. It needs to be given intravenously (by IV) in a hospital.

• #4 IDSA 2016 Clinical Practice Guideline for the Treatment of Coccidioidomycosis

  https://www.idsociety.org/practice-guideline/coccidioidomycosis/

  For the treatment of patients with very severe and/or rapidly progressing acute pulmonary or disseminated coccidioidomycosis, we recommend the use of AmB until the patient has stabilized, followed by fluconazole (strong, low). […] The development of symptomatic coccidioidomycosis during pregnancy should prompt consideration of starting administration of antifungal therapy (strong, moderate). […] For women who develop initial nonmeningeal coccidioidal infection during their first trimester of pregnancy, intravenous AmB is recommended (strong, moderate). […] Antifungal therapy is recommended for all patients with HIV infection with clinical evidence of coccidioidomycosis and a peripheral blood CD4+ T-lymphocyte count 250 cells/L (strong, moderate).

• #4

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4711193/

  A case report study indicated a relapse rate of 78% when therapy was discontinued, leading to the recommendation that triazole therapy for coccidioidal meningitis should be life-long. […] There is a role for surgical therapy in coccidioidomycosis. […] Because the cellular immune response is critical to control of coccidioidomycosis, patients with such an immune deficiency require special consideration. Most experts would recommend antifungal therapy for all types of coccidioidomycosis, including primary pulmonary disease, in such patients. […] For those with severe disease requiring hospitalization, initial therapy with amphotericin B combined with a triazole antifungal is recommended. […] The use of azole antifungals during pregnancy has been controversial.

• #4 Coccidioidomycosis (Valley Fever) in Primary Care | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0215/p221.html

  Nonpregnant, nonbreastfeeding adults are typically treated with oral fluconazole (Diflucan) or itraconazole (Sporanox). […] Children are usually treated with oral fluconazole. […] Pregnant women are normally treated with intravenous amphotericin B, although fluconazole can be considered during the second and third trimesters. […] If antifungals are given, serial complement fixation titers should be monitored for at least two years because antifungal treatment has been associated with delayed dissemination. […] Antifungal therapy is often discontinued after three to 12 months if complement fixation titers stabilize, chest radiography shows stabilization, and symptoms resolve. […] Antifungal therapy should be considered if symptoms develop during pregnancy. […] If coccidioidal meningitis is confirmed, lifelong antifungal therapy is indicated.

• #4 Updated IDSA Guidelines on Valley Fever: Early Diagnosis Key to Treatment – Infectious Disease Advisor

  https://www.infectiousdiseaseadvisor.com/features/updated-idsa-guidelines-on-valley-fever-early-diagnosis-key-to-treatment/

  Early diagnosis of coccidioidomycosis is important in order to reduce unnecessary tests and treat the condition, according to updated guidelines released by the Infectious Diseases Society of America (IDSA) and published in the journal Clinical Infectious Disease. […] Those patients who do need therapy should be treated with an antifungal medication such as fluconazole, according to the guidelines. The medication does not cure the infection but suppresses the symptoms. […] The guidelines recommend treatment with fluconazole for women with complications from valley fever who are in their second or third trimester of pregnancy. That is a change from the previous guidelines, which recommended pregnant women be treated with amphotericin B. Fluconazole is not toxic to the mother, can be taken orally and, while not recommended during the first trimester, appears safe during the second and third trimester, the guidelines note. The infection itself is not harmful to the fetus.

• #4 Coccidioidomycosis: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/coccidioidomycosis

  Preferred Therapy: Amphotericin B deoxycholate 0.7-1.0 mg/kg IV daily (AII), or Lipid formulation amphotericin B 3-5 mg/kg IV daily (AIII), particularly for those with underlying renal dysfunction. […] Use until clinical improvement, then switch to triazole (fluconazole 400 mg PO daily or itraconazole 200 mg PO twice daily) (BIII). […] Preferred Therapy: Fluconazole 800-1,200 mg PO once daily (AII). […] Discontinuation can be considered after the following: Clinical response to 3-6 months of antifungal therapy, and CD4 count 250 cells/mm3, and Virologic suppression on ART. […] Discontinuation may be considered after 12 months of therapy based on clinical and serological response, and the decision should be made in consultation with experts (BIII). […] Relapse has been reported in 80% of patients after stopping triazoles; suppressive therapy at treatment doses should be lifelong. Discontinuation of therapy is not recommended (AII).

• #4 HIE Multimedia – Valley fever

  https://adamcertificationdemo.adam.com/content.aspx?productid=117&pid=1&gid=001322

  If you have a healthy immune system, the disease almost always goes away without treatment. Your provider may suggest bed rest and treatment for flu-like symptoms until your fever disappears. […] If you have a weak immune system, you may need antifungal treatment with amphotericin B, fluconazole, or itraconazole. Itraconazole is the medicine of choice in people with joint or muscle pain. […] Sometimes surgery is needed to remove the infected part of the lung (for chronic or severe disease).

• #4 Immune Deficits in Some Valley Fever Patients Hinder Response to Antifungal Treatment

  https://www.contagionlive.com/view/immune-deficits-in-some-valley-fever-patients-hinder-response-to-antifungal-treatment

  Research into new antifungal treatments, including drugs in phase two and three trials, offers hope for patients who do not respond to current therapies. […] Antifungal treatments are effective for many patients, but for others, theyre not enough. […] Despite the availability of antifungal drugs, some patients, even when treated with the correct medication, simply do not respond. […] In response to these treatment challenges, Thompson and a group of researchers from UC San Diego, UCLA, Texas, and Northern Arizona University (NAU) have spent the past years focusing on the host response to valley fever. […] If we really understand how we control the infection, perhaps we can create a vaccine that will prevent it completely. […] While much of the focus has been on diagnosis and immune response, there is also news in the development of new antifungal treatments.

• #4 Understanding and Managing Valley Fever | Banner Health

  https://www.bannerhealth.com/services/infectious-disease/treatment/valley-fever

  Along with medication, your health care provider may recommend treatments to help reduce your symptoms: OTC pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil) may help with muscle aches, joint pain and fever. […] Cough suppressants or expectorants can help reduce coughing and irritation. […] Rest and fluids can help support your bodys immune system so you can recover. […] Physical therapy and reconditioning may help with fatigue and muscle aches as you recover. […] If you have Valley fever and your symptoms are getting worse or you have new health concerns, contact your health care provider. Youll also need regular follow-up appointments with your provider to monitor your treatment progress.

• #4 Impact and Control of Valley Fever – A Workshop | National Academies

  https://www.nationalacademies.org/our-work/impact-and-control-of-valley-fever-a-workshop

  Coccidioidomycosis, or „Valley fever”, is a fungal disease caused by inhalation of Coccidioides spores from the soil. […] Despite the public health burden of this disease, a lack of research investment has led to limited options for treatment and control. […] The workshop will explore prospects for control of the disease through vaccination. Specifically, the workshop will feature invited presentations and discussions on the following topics: […] Overview of valley fever in human and animal populations to include current surveillance programs and diagnostic and treatment options; […] Strengthening research and research partnerships on overall fungal diseases for therapeutics or vaccine development; […] Regulatory pathways for a fungal disease vaccine; […] Vaccine acceptance and communication.

• #4 Do all patients with primary pulmonary coccidioidomycosis need antifungal therapy? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/89/8/451

  No. Patients diagnosed with primary pulmonary coccidioidomycosis (PPC) who are asymptomatic or mildly symptomatic do not require treatment and can be monitored closely. Treatment should be initiated in patients with severe disease, extrathoracic dissemination, or risk factors such as immunosuppression. […] The decision to treat PPC should be individualized, since most patients will not require antifungal treatment. The current Infectious Diseases Society of America (IDSA) guidelines recommend patient education, close observation, and supportive measures such as a reconditioning physical therapy program for patients with mild symptoms, or for those who have significantly improved by the time of diagnosis. Treatment is recommended for patients with prolonged symptoms (for example, symptoms that persist for 2 months or severe night sweats for 3 weeks), extensive pulmonary involvement (eg, 50% involvement of one or both lungs), or severe disease requiring hospitalization. Additionally, guidelines recommend treating patients with concurrent diabetes and those with underlying cellular immune deficiencies, such as transplant patients on antirejection therapy, persons with human immunodeficiency virus infection with CD4 counts below 250, and patients on high-dose corticosteroids. Treatment can be considered for patients of African or Filipino descent.

• #5 Antifungal Therapy | UC Davis Center for Valley Fever

  https://health.ucdavis.edu/valley-fever/about-valley-fever/treatment-antifungal-therapy/index.html

  In severe or refractory coccidioidal disease, an intravenous amphotericin B formulation is considered the drug of choice. […] The introduction of azoles was a significant breakthrough in the treatment of coccidioidomycosis for both meningeal and non-meningeal disease. […] Fluconazole was the next to be developed, and it still remains the preferred triazole due to its excellent bioavailability, tolerability, CNS penetration, slow clearance (24-30 hour half-life), little hepatotoxicity, renal clearance, no endocrine side effects, reasonable response rates in prior reports, and generally lower costs. […] The disadvantage of azole therapy is the inability to eradicate the fungus, which seems to be a class effect, thus treatment is continued indefinitely as a suppressive rather than curative therapy for CM although newer formulations and agents may offer mean fungicidal concentrations achievable in clinical care.

• #5 Valley Fever: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17754-valley-fever

  Treatment for Valley fever will depend on how severe your condition is and how your provider wants to manage it. They might recommend keeping an eye on your symptoms before prescribing medications, or they might treat you to reduce the risk of serious illness. If you have a serious or ongoing infection or if you have risk factors for severe illness (like chronic pulmonary disease) they may prescribe antifungal medications. […] If you need treatment for Valley fever, your healthcare provider may prescribe one of these medications: Fluconazole. Itraconazole. Amphotericin B (AmB). […] Your healthcare provider may prescribe antifungal treatments for Valley fever for three to six months. Your treatment may last longer depending on your case.

• #5

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4711193/

  A case report study indicated a relapse rate of 78% when therapy was discontinued, leading to the recommendation that triazole therapy for coccidioidal meningitis should be life-long. […] There is a role for surgical therapy in coccidioidomycosis. […] Because the cellular immune response is critical to control of coccidioidomycosis, patients with such an immune deficiency require special consideration. Most experts would recommend antifungal therapy for all types of coccidioidomycosis, including primary pulmonary disease, in such patients. […] For those with severe disease requiring hospitalization, initial therapy with amphotericin B combined with a triazole antifungal is recommended. […] The use of azole antifungals during pregnancy has been controversial.

• #5 Coccidioidomycosis and Valley Fever Treatment & Management: Approach Considerations, Antifungal Medications, Investigational Agents

  https://emedicine.medscape.com/article/215978-treatment

  Individuals with chronic progressive fibrocavitary pneumonia should immediately start antifungal treatment with an oral azole and continue therapy for at least 1 year. […] All patients with disseminated coccidioidomycosis warrant prolonged antifungal treatment. […] The treatment of septic shock associated with coccidioidomycosis relies on the use of antifungal therapy and appropriate resuscitative and supportive measures. […] Fluconazole can be used in the treatment of mild to moderate meningitis and, occasionally, life-threatening meningitis in patients who opt against amphotericin B or who have contraindications to its use. […] The usual dosage of fluconazole is 400 mg/day, but many physicians start with 800 or 1000 mg/day. […] Treatment of active disease is the same as in other patients; however, if the CD4+ cell count is less than 250/L, antifungal therapy should continue until the count recovers to above 250 cells/L. Indefinitely continue suppressive therapy after active disease (ie, secondary prophylaxis) with oral itraconazole (200 mg twice a day) or fluconazole (400 mg each day), regardless of the CD4+ cell count.

• #5 Treating and Managing Coccidioidomycosis | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/coccidioidomycosis/treating-and-managing

  Most individuals with coccidioidomycosis do not require specific treatment. Treatment with antifungal medications may be prescribed for those with more severe symptoms or symptoms lasting eight weeks or longer. […] Treatment typically lasts for several months, and the length will vary depending on how well your body responds. More severe cases may require hospitalization and intravenous (IV) antifungal medication. In patients with depressed immune systems or with disease outside the lung (disseminated), lifelong treatment may be required. In very few individuals, surgery may be required to remove portions of infected or damaged lung. […] If your condition is more severe, you should stay in touch with your doctor and receive follow-up blood testing and lung imaging, such as chest X-rays or CT scans, for at least the first year. This will ensure that if you do develop chronic or disseminate infections, they are caught and treated immediately. If your doctor thinks you need additional medical attention, they may refer you to a pulmonary or infectious disease specialist, although this is less likely to happen in regions where the primary care provider is familiar with the disease.

• #5 Immune Deficits in Some Valley Fever Patients Hinder Response to Antifungal Treatment

  https://www.contagionlive.com/view/immune-deficits-in-some-valley-fever-patients-hinder-response-to-antifungal-treatment

  Research into new antifungal treatments, including drugs in phase two and three trials, offers hope for patients who do not respond to current therapies. […] Antifungal treatments are effective for many patients, but for others, theyre not enough. […] Despite the availability of antifungal drugs, some patients, even when treated with the correct medication, simply do not respond. […] In response to these treatment challenges, Thompson and a group of researchers from UC San Diego, UCLA, Texas, and Northern Arizona University (NAU) have spent the past years focusing on the host response to valley fever. […] If we really understand how we control the infection, perhaps we can create a vaccine that will prevent it completely. […] While much of the focus has been on diagnosis and immune response, there is also news in the development of new antifungal treatments.

• #5 Valley Fever: Pathogenesis and Evolving Treatment Options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10774831/

  Most cases of coccidioidomycosis do not require treatment or can simply be resolved via symptomatic treatment. These symptomatic treatments can include nonsteroidal anti-inflammatory drugs (NSAIDs) as well as rest. If symptoms do not subside, there are two classes of drugs generally used for treatment: azoles and amphotericin B. Azoles work by inhibiting the synthesis of ergosterol in the cell membrane. The current preferred drug to treat coccidioidomycosis is fluconazole (Diflucan, Pfizer, New York, New York, United States). The recommended dosage of fluconazole is between 400 mg and 1200 mg daily. A second medication that is used for the treatment of coccidioidomycosis is amphotericin B. This drug is the drug of choice in severe or refractory cases of coccidioidomycosis. Recent studies show that corticosteroids can be used to hasten recovery from a coccidioidomycosis infection. Treatment of immunocompromised hosts living in an endemic area may differ from that of immunocompetent hosts. For patients with HIV infection, all patients receive an antifungal therapy consisting of either fluconazole or itraconazole. In the case of transplant recipients, all patients that live in an endemic area should be screened prior to transplantation. Lastly, special considerations must be taken for pregnant patients. Women that acquire coccidioidomycosis during their second or third trimester should take a triazole such as fluconazole as treatment.

• #5 Therapies – Valley Fever Solutions

  https://valleyfeversolutions.com/therapies/

  Valley Fever, or coccidioidomycosis, is a debilitating fungal disease with limited treatment options. Current antifungal drugs often have significant side effects and are not effective for all patients. Nikkomycin Z (NikZ) represents a groundbreaking scientific advancement that promises to revolutionize Valley Fever treatment and treat other fungi as well. […] NikZ offers a more effective treatment option for patients, particularly for those who dont respond well to available drugs. […] NikZ does not cause any significant side effects (in human studies to date), a sharp contrast with the burden of treatment-related complications experienced by many patients taking approved drugs. […] With its novel mechanism of action, Valley Fever Solutions new formulation of NikZ improved efficacy 500% with a sustained, continuous dosing.

• #5 FAQs | Valley Fever Center For Excellence

  https://vfce.arizona.edu/valley-fever-people/faqs

  Is there a cure for Valley fever? No. Researchers within our center and in the U.S. are working on the development of a prophylactic vaccine. We are also in the early phases of testing a drug that shows promise of a cure in the future. […] Which antifungal medications are used to treat Valley fever? The „azole” family of antifungal drugs are frequently used. These are oral preparations of ketoconazole, itraconazole and fluconazole. Each have various side-effects and may be expensive. The azoles do not kill the fungus but they control it. Amphotericin B is an antifungal medication that is used in serious and fulminant infections. It may be administered intravenously or intrathecally (injecting the medication directly into the fluid surrounding the brain). […] Will antibiotics help a Valley fever infection? No. Coccidioidal pneumonia is not treated with routine antibiotics (such as penicillin, cephalosporin, erythromycin) because it is caused by a fungus and „regular” pneumonia is caused by bacteria. There are antifungal medications that may be used to treat Valley fever.

• #6 HIE Multimedia – Valley fever

  https://adamcertificationdemo.adam.com/content.aspx?productid=117&pid=1&gid=001322

  If you have a healthy immune system, the disease almost always goes away without treatment. Your provider may suggest bed rest and treatment for flu-like symptoms until your fever disappears. […] If you have a weak immune system, you may need antifungal treatment with amphotericin B, fluconazole, or itraconazole. Itraconazole is the medicine of choice in people with joint or muscle pain. […] Sometimes surgery is needed to remove the infected part of the lung (for chronic or severe disease).

• #6 Valley Fever: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/17754-valley-fever

  Treatment for Valley fever will depend on how severe your condition is and how your provider wants to manage it. They might recommend keeping an eye on your symptoms before prescribing medications, or they might treat you to reduce the risk of serious illness. If you have a serious or ongoing infection or if you have risk factors for severe illness (like chronic pulmonary disease) they may prescribe antifungal medications. […] If you need treatment for Valley fever, your healthcare provider may prescribe one of these medications: Fluconazole. Itraconazole. Amphotericin B (AmB). […] Your healthcare provider may prescribe antifungal treatments for Valley fever for three to six months. Your treatment may last longer depending on your case.

• #6 Coccidioidomycosis: Adult and Adolescent OIs | NIH

  https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/coccidioidomycosis

  Preferred Therapy: Amphotericin B deoxycholate 0.7-1.0 mg/kg IV daily (AII), or Lipid formulation amphotericin B 3-5 mg/kg IV daily (AIII), particularly for those with underlying renal dysfunction. […] Use until clinical improvement, then switch to triazole (fluconazole 400 mg PO daily or itraconazole 200 mg PO twice daily) (BIII). […] Preferred Therapy: Fluconazole 800-1,200 mg PO once daily (AII). […] Discontinuation can be considered after the following: Clinical response to 3-6 months of antifungal therapy, and CD4 count 250 cells/mm3, and Virologic suppression on ART. […] Discontinuation may be considered after 12 months of therapy based on clinical and serological response, and the decision should be made in consultation with experts (BIII). […] Relapse has been reported in 80% of patients after stopping triazoles; suppressive therapy at treatment doses should be lifelong. Discontinuation of therapy is not recommended (AII).

• #6 FAQs | Valley Fever Center For Excellence

  https://vfce.arizona.edu/valley-fever-people/faqs

  What is the length of treatment for Valley fever? The length of treatment depends on the severity of symptoms and disease and complications of the disease. Some patients take antifungal medication for a few months; others need life time therapy. […] Why won’t my doctor prescribe any medication when I feel really sick? Before the availability of antifungal medications, at least 95% of patients with pulmonary Valley fever got better without any treatment. Studies have not been completed yet to determine if drug therapy hastens the resolution of immediate symptoms or prevents subsequent complications. The physician usually monitors the progress of the patient by chest x-rays, following the cocci serology (blood test) titer and the severity and duration of symptoms. This may require frequent visits to the doctor. If weight loss and night sweats continue, infiltrates in the lungs enlarge, and the inability to work persists, antifungal medication usually is considered.

• #6 Immune Deficits in Some Valley Fever Patients Hinder Response to Antifungal Treatment

  https://www.contagionlive.com/view/immune-deficits-in-some-valley-fever-patients-hinder-response-to-antifungal-treatment

  Thompson highlights two promising drugs currently in phase two and three clinical trials, Lorafin and Fasmanid. […] These drugs are really needed, and were hopeful theyll be available soon. […] Until then, the medical community continues to rely on existing therapies, though these new options could offer hope for patients whose infections do not respond to current treatments.

• #6 Reddit – The heart of the internet

  https://www.reddit.com/r/LightningInABottle/comments/1d4944s/psa_valley_fever/

  Doctors and urgent cares will most likely always just prescribe you anti-biotics. Unfortunately, antibiotics will make valley fever symptoms worse. […] THE ONLY WAY TO GET TREATED IS WITH ANTI-FUNGAL meds! There are only 2 available. […] Please Please Please just get checked for valley fever if you go to the doctor. Its a simple blood test.

• #7 Valley fever | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/valley-fever?content_id=CON-20378744

  Valley fever usually involves supportive care and sometimes medications. […] If symptoms don’t improve, last a long time or become worse, or you’re at increased risk of complications, your doctor may prescribe an antifungal medication, such as fluconazole. Antifungal medications are also used for people with chronic or disseminated disease. […] The antifungal drugs fluconazole (Diflucan) or itraconazole (Sporanox, Tolsura) are generally used for all but the most serious forms of coccidioidomycosis disease. […] More serious infection may first be treated with an intravenous antifungal medication such as amphotericin B (Abelcet, Ambisome, others). […] Three newer medications voriconazole (Vfend), posaconazole (Noxafil) isavuconazonium sulfate (Cresemba) may also be used to treat more-serious infections.

• #7

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4711193/

  For severely ill patients with multisite dissemination, the management is the same as for those with diffuse pulmonary coccidioidomycosis and includes initial amphotericin B with a triazole antifungal. […] For less severe disease, an oral triazole antifungal, either fluconazole or itraconazole at a daily dose of 400 mg, is reasonable. […] The length of therapy for disseminated disease is undefined. At least one year of therapy should be considered. […] CNS disease represents a unique form of coccidioidal dissemination. […] Initial therapeutic attempts involved the direct installation of amphotericin B into the subarachnoid space. […] In 1990’s, studies indicating that both oral fluconazole and itraconazole were effective for meningeal disease and ushered in a new era in the management of coccidioidal meningitis.

• #7 IDSA 2016 Clinical Practice Guideline for the Treatment of Coccidioidomycosis

  https://www.idsociety.org/practice-guideline/coccidioidomycosis/

  We recommend initiating antifungal treatment for patients who, at the time of diagnosis, have significantly debilitating illness (strong, low). […] For patients at the time of diagnosis with extensive pulmonary involvement, with concurrent diabetes, or who are otherwise frail because of age or comorbidities, we recommend initiating antifungal treatment. Some experts would also include African or Filipino ancestry as indications for treatment (strong, low). […] If treatment is begun in nonpregnant adults, the treatment should be an orally absorbed azole antifungal (eg, fluconazole) at a daily dose of 400 mg (strong, low). […] We recommend against the use of antifungal therapy for patients with an asymptomatic cavity (strong, low). […] We recommend that patients with symptomatic chronic cavitary coccidioidal pneumonia be treated with an oral agent such as fluconazole or itraconazole (strong, moderate).

• #8 Valley Fever: Pathogenesis and Evolving Treatment Options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10774831/

  Most cases of coccidioidomycosis do not require treatment or can simply be resolved via symptomatic treatment. These symptomatic treatments can include nonsteroidal anti-inflammatory drugs (NSAIDs) as well as rest. If symptoms do not subside, there are two classes of drugs generally used for treatment: azoles and amphotericin B. Azoles work by inhibiting the synthesis of ergosterol in the cell membrane. The current preferred drug to treat coccidioidomycosis is fluconazole (Diflucan, Pfizer, New York, New York, United States). The recommended dosage of fluconazole is between 400 mg and 1200 mg daily. A second medication that is used for the treatment of coccidioidomycosis is amphotericin B. This drug is the drug of choice in severe or refractory cases of coccidioidomycosis. Recent studies show that corticosteroids can be used to hasten recovery from a coccidioidomycosis infection. Treatment of immunocompromised hosts living in an endemic area may differ from that of immunocompetent hosts. For patients with HIV infection, all patients receive an antifungal therapy consisting of either fluconazole or itraconazole. In the case of transplant recipients, all patients that live in an endemic area should be screened prior to transplantation. Lastly, special considerations must be taken for pregnant patients. Women that acquire coccidioidomycosis during their second or third trimester should take a triazole such as fluconazole as treatment.

• #8 Do all patients with primary pulmonary coccidioidomycosis need antifungal therapy? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/89/8/451

  Most patients do not require treatment, but the decision to treat should be individualized and based on a variety of factors. First-line antifungal treatment consists of fluconazole at least 400 mg daily, with certain exceptions such as avoiding its use in the first trimester of pregnancy. Whether treatment is or is not provided, close follow-up of all patients is recommended.

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