Practice guidelines for the treatment of coccidioidomycosis. Clin. Infect. Dis

Management of patients diagnosed with coccidioidomycosis involves de®ning the extent of infection and assessing host fac-tors that predispose to disease severity. Patients with relatively localized acute pulmonary infections and no risk factors for complications often require only periodic reassessment to dem-onstrate resolution of their self-limited process. On the other hand, patients with extensive spread of infection or at high risk of complications because of immunosuppression or other pre-existing factors require a variety of treatment strategies that may include antifungal therapy, surgical debridement, or both. Amphotericin B is often selected for treatment of patients with respiratory failure due to Coccidioides immitis or rapidly pro-gressive coccidioidal infections. With other more chronic man-ifestations of coccidioidomycosis, treatment with ¯uconazole, itraconazole, or ketoconazole is common. Duration of therapy often ranges from many months to years, and, for some pa-tients, chronic suppressive therapy is needed to prevent relapses