title: Fluconazole in the treatment of chronic pulmonary and nonmeningeal disseminated coccidioidomycosis. NIAID Mycoses Study Group.
abstract: OBJECTIVE
  To determine the efficacy and safety of fluconazole as treatment for coccidioidomycosis.
  
  
  METHODS
  This was a multicenter, open-label, single-arm study. Of 78 patients enrolled, 22 had soft-tissue, 42 had chronic pulmonary, and 14 had skeletal coccidioidomycosis. Forty-nine had at least one concomitant disease, 7 of whom had HIV infection. Patients were given oral fluconazole 200 mg/d. Nonresponders were increased to 400 mg/d. Treatment courses were long: a mean of 323 +/- 230 days at 200 mg and 433 +/- 178 days at 400 mg. Predefined assessment of disease-related abnormalities was performed at the time of enrollment and repeated at least every 4 months. A satisfactory response was defined as any reduction of baseline abnormality by month 4 and at least 51% reduction by month 8.
  
  
  RESULTS
  Among 75 evaluable patients, a satisfactory response was observed in 12 (86%) of the 14 patients with skeletal, 22 (55%) of the 40 patients with chronic pulmonary, and 16 (76%) of the 21 patients with soft-tissue disease. Five patients (7%) required modification of treatment due to toxicity. Forty-one patients who responded were followed off drug. Fifteen (37%) of them experienced reactivation of infection.
  
  
  CONCLUSIONS
  Fluconazole 200 or 400 mg/d is well tolerated and a moderately effective treatment for chronic pulmonary or nonmeningeal disseminated coccidioidomycosis. The relapse rate following therapy is high. Treatment trials with higher doses appear warranted. The relative efficacy of fluconazole versus other azoles or amphotericin B remains unknown.
authors.affiliation: Department of Medicine, University of California, San Diego.
authors.forename: A
authors.initials: A
authors.lastname: Catanzaro
authors.forename: J N
authors.initials: JN
authors.lastname: Galgiani
authors.forename: B E
authors.initials: BE
authors.lastname: Levine
authors.forename: P K
authors.initials: PK
authors.lastname: Sharkey-Mathis
authors.forename: J
authors.initials: J
authors.lastname: Fierer
authors.forename: D A
authors.initials: DA
authors.lastname: Stevens
authors.forename: S W
authors.initials: SW
authors.lastname: Chapman
authors.forename: G
authors.initials: G
authors.lastname: Cloud
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003047:Coccidioidomycosis / Q000188:drug therapy*; D015725:Fluconazole / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008172:Lung Diseases, Fungal / Q000188:drug therapy*; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D015725:Fluconazole