Treatment of coccidioidomycosis with miconazole

Miconazole was injected intravenously in six patients with coccidioidomycosis. Two patients received 101 and 185 g, respectively, without clinical response and with persistence of positive cultures for Coccidioides immitis. In one patient, symptoms were suppressed when amphotericin B was given with miconazole, but new lesions developed with miconazole alone (total dose, 963 g). Three patients received smaller doses: 30.6 g before death from an unrelated complication; 17 and 22.3 g before development of severe allergic reactions. Because of the high rate of initial failures and relapses, miconazole is not recommended as primary therapy for coccidioidomycosis.