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Insights into current coccidioidomycosis therapeutic pathways
Brent Edwards1, Rebecca Ripperton1, Adeleine Tilley1
1Department of Medicine, Division of Infectious Diseases, University of Colorado Denver, Aurora, Colorado, USA.
Antimicrobial Agents and Chemotherapy
|November 18, 2025
Summary
Coccidioidomycosis treatment often starts with fluconazole, but some patients require switches to other antifungals, especially for severe cases. Further optimization of treatment strategies is needed for better outcomes in coccidioidomycosis management.
Area of Science:
- Mycology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Coccidioidomycosis, a fungal infection endemic to specific regions, is typically treated with oral fluconazole.
- Severe manifestations of coccidioidomycosis can lead to treatment failure with first-line therapies.
Purpose of the Study:
- To analyze antifungal treatment pathways for coccidioidomycosis.
- To identify factors influencing treatment switches.
- To compare patient outcomes based on different treatment courses.
Main Methods:
- Retrospective cohort study using the TriNetX database (January 2010 - March 2024).
- Identified patients with coccidioidomycosis using ICD-10-CM codes.
- Defined treatment switches as changes in antifungal agents for ≥3 consecutive days.
Main Results:
- 87.4% of 1,909 patients initiated fluconazole; 11.2% switched antifungals.
- Common switches included fluconazole to posaconazole and amphotericin B to fluconazole.
- Coccidioidal meningitis patients switching from fluconazole showed higher ICU admission and hospitalization rates.
Conclusions:
- Fluconazole remains the primary first-line antifungal for coccidioidomycosis, with amphotericin B as a common second choice.
- While most patients respond to initial fluconazole, therapeutic strategy optimization is crucial for severe coccidioidomycosis.
- Further research into advanced treatment protocols is warranted for refractory cases.
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