Indications for Treatment:

• Patients who have clinically mild infection, such as focal pneumonia
• Patients with positive coccidioidal serologies but with mild or without clinical illness

Preferred Therapy:

• Fluconazole 400 mg PO once daily (AII), or
• Itraconazole 200 mg PO three times daily for 3 days, followed by 200 mg twice daily (AII)

Alternative Therapy (for Patients Who Failed to Respond to Fluconazole or Itraconazole):

• Voriconazole loading dose of 400 mg twice daily for the first day followed by 200 mg PO twice daily (BIII), or
• Posaconazole (extended-release tablet) 300 mg PO twice daily for the first day and then 300 mg daily (BIII)

Preferred Therapy:

• Lipid formulation amphotericin B 3–5 mg/kg IV daily (AIII), or
• Amphotericin B deoxycholate 0.7–1.0 mg/kg IV daily (AII)
• Use until clinical improvement, then switch to triazole (BIII)

• Some specialists recommend combining amphotericin B with a triazole (fluconazole or itraconazole 400 mg daily) and continue the triazole once amphotericin B is stopped (CIII)

Preferred Therapy:

• Fluconazole 400–800 mg IV or PO once daily (AII)

Alternative Therapy:

• Itraconazole 200 mg PO two to three-times daily (BII), or
• Voriconazole 200–400 mg PO twice daily (BIII), or
• Posaconazole (delayed release tablet) 300 mg twice on first day, then 300 mg once daily (CIII), or
• Isavuconazole 372 mg every 8 hours for 6 doses, then 372 mg daily (CIII)
• Intrathecal amphotericin B (AIII) when triazole antifungals are not effective. Use in consultation with a specialist and should be administered by a clinician experienced in this drug delivery technique. 

• Azole antifungal agents are contraindicated and should be avoided in the first trimester of pregnancy because of potential teratogenic effect and risk of spontaneous abortion (AIII).
• Amphotericin B deoxycholate 0.7–1.0 mg/kg IV daily (AIII), or
• Lipid formulation amphotericin B 3–5 mg/kg IV daily (AIII)