People with healthy immune systems who are diagnosed with coccidioidomycosis don't necessarily require treatment, as the symptoms are usually mild and clear up on their own. For people with compromised immune systems, coccidioidomycosis can be progressive and can cause serious respiratory distress and treatment is deemed necessary. Treatment is also required if coccidioidomycosis has spread beyond the lungs, to other organs and tissues in the body (especially the central nervous system).
If the infection is mild, causing minimal lung problems or not causing any symptoms (but with positive antibody tests), oral fluconazole (Diflucan) or itraconazole (Sporanox) at doses of 400 mg a day is recommended.
If the infection is causing moderate or severe lung problems, or the infection is causing disease elsewhere in the body, amphotericin B (Fungizone) is the recommended treatment. It is administered through an intravenous (IV) line, usually in a hospital, until the patient is feeling better. Amphotericin B can cause numerous side effects, including fever, chills, muscle pain, nausea, vomiting, kidney problems, potassium deficiency, decreased white blood cells, and anemia. Liposomal formulations of amphotericin B—which attach the drug to microscopic spheres of fat—are a possibility (but are not officially approved for the treatment of coccidioidomycosis), as they have been shown to be just as effective and somewhat less toxic than standard amphotericin B for the treatment of several types of fungal infections. Liposomal formulations include Abelcet, Amphotec, and AmBisome.
Amphotericin B and fluconazole or itraconazole are sometimes taken together to maximize treatment.
When the infection strikes the brain, causing meningitis, the preferred treatment is fluconazole at a dose ranging from 400 to 800 mg per day. Though fluconazole is preferred, other antifungal drugs have been used successfully, including itraconazole, voriconazole (Vfend) and posaconazole (Noxafil). In cases where the meningitis does not respond to treatment, amphotericin B is recommended.
After an initial course of treatment, either fluconazole or itraconazole is continued to prevent the coccidioidomycosis from recurring. Treatment may be discontinued after it has been taken for 12 months and the patient's CD4 count is once again above 250 cells.
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