People with healthy immune systems who are diagnosed with histoplasmosis don't necessarily require treatment, as the symptoms are usually mild and clear up on their own. For people with compromised immune systems, histoplasmosis can be progressive and life threatening and, as a result, often requires treatment.
It is important to treat histoplasmosis aggressively. For the first two weeks of treatment, the drug amphotericin B (Fungizone®) is given every day through an IV line, usually while staying in a hospital. Amphotericin B treatment is continued for approximately 3 to 10 days, depending on how quickly the patient's symptoms improve.
Amphotericin B can cause side effects, some of them serious. Side effects include nausea, fever, chills, muscle pain, low potassium levels, damage to the bone marrow and its ability to produce red blood cells and white blood cells, and kidney damage. Tip: Take a regular dose of acetaminophen (e.g., Tylenol®), ibuprofen (e.g., Advil®), naproxen (e.g., Aleve®), and/or diphenhydramine (e.g., Benadryl®) approximately half an hour before receiving amphotericin B – this can help prevent/reduce some side effects during and after receiving the infusion.
At least one study has demonstrated that liposomal amphotericin B – a drug involving microscopic spheres of lipids (fats) that contain amphotericin B – is more effective and less toxic than the standard form of amphotericin B (Fungizone®). If liposomal amphotericin B is used, experts recommend using the brand AmBisome® over that of the brands Abelcet® or Amphotec®.
After completing 3 to 10 days of amphotericin B treatment, the drug is usually stopped and another drug, itraconazole (Sporanox®), is immediately started. This is necessary to help prevent the histoplasmosis from recurring. Itraconazole is taken by mouth, twice a day. Alternatives to itraconazole include fluconazole (Diflucan®), which is taken by mouth once a day, or weekly IV infusions of amphotericin B. These "maintenance" treatments are often continued for life. It is not clear if these maintenance treatments can be stopped, even if the T-cell count improves in response to anti-HIV drug treatment.
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