Treatment of refractory coccidioidomycosis with voriconazole or posaconazole

Michelle M. Kim, Holenarasipur R. Vikram, Shimon Kusne, Maria Teresa Seville, Janis E. Blair

Research output: Contribution to journalArticlepeer-review

58 Scopus citations

Abstract

Background. Coccidioidomycosis is a fungal infection of the desert southwestern United States. It may be self-limited or may require antifungal therapy. Currently used triazoles (eg, fluconazole and itraconazole) have largely supplanted amphotericin B, which is fraught with adverse effects. Limited case reports and small open-label trials show that voriconazole and posaconazole benefit patients with coccidioidomycosis refractory to first-line agents.Methods.We conducted a retrospective review of patients prescribed voriconazole or posaconazole for coccidioidomycosis at our institution between 1 January 2006 and 1 August 2010. Outcomes were assessed with both a retrospectively applied Mycosis Study Group score (ie, a composite score for symptoms, serology, and radiographic findings) and the documented impressions of treating medical practitioners.Results.Twenty-one patients who received voriconazole and 16 who received posaconazole met study criteria. After a median duration of 6 months of voriconazole treatment, 14 of 21 patients (67%) were improved in overall status, 5 were unchanged, and 2 were unresponsive to voriconazole. After a median of 17 months of posaconazole treatment, 12 of 16 patients (75%) showed improvement, 1 was unchanged, and 3 were unresponsive due to medication intolerance or relapsed infection.Conclusions.Voriconazole and posaconazole are reasonable but not infallible options for salvage treatment of refractory coccidioidomycosis. Prospective comparative trials are required to provide further insights into their efficacy and utility.

Original languageEnglish (US)
Pages (from-to)1060-1066
Number of pages7
JournalClinical Infectious Diseases
Volume53
Issue number11
DOIs
StatePublished - Dec 1 2011

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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