Treatment

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• most patients with primary infection do not require specific therapy
  • in severe acute infection treatment with amphotericin or oral azoles should be considered
    
    
• patients with disseminated disease require treatment with amphotericin or oral azoles
  
  
• if there is severe haemoptysis or cavities that rupture or enlarge, then pulmonary resection has a role
  
  
• meningitis may be treated by administration of amphotericin directly into the cerebrospinal fluid or high dose ketoconazole

Notes:

• study evidence showed that olorofim, a first-in-class antifungal agent, demonstrated clinical success in patients with limited or no therapeutic options (clinical success rate 75.6% [95% CI, 59.7% to 87.6%] at day 42, 73.2% [57.1% to 85.8%] at day 84) (2)

Reference

1. Galgiani JN et al. 2016 Infectious Diseases Society of America (IDSA) clinical practice guideline for the treatment of coccidioidomycosis. Clin Infect Dis. 2016 Sep 15;63(6):e112-46.
2. Fariba M. Donovan, Royce H. Johnson, Thomas F. Patterson, et al. Olorofim in Treatment of Patients With Poorly Controlled Disseminated Coccidioidomycosis (https://www.acpjournals.org/doi/abs/10.7326/ANNALS-26-00103): A Single-Group, Open-Label, Phase 2b, Multicenter Study. Ann Intern Med.[Epub 21 July 2026].