A person who has had an exposure to Coccidioides immitis in the laboratory should be considered for prophylactic antifungal therapy.
Routine prophylactic regimen - one of the following:
(1) fluconazole 400 mg po qd for 6 weeks
(2) itraconazole 400 mg po qd for 6 weeks
More aggressive management is indicated if the person:
(1) is immunosuppressed
(2) is from an ethnic group at greater risk for infection (Filipino, other)
(3) has comorbid condition (COPD, other)
Prophylaxis for a pregnant woman who has been exposed:
(1) prophylaxis prior to delivery:
(1a) minimal risk: observe closely
(1b) any other risk: intravenous amphotericin B weekly for 6 weeks
(2) prophylaxis after delivery: either continue intravenous amphotericin B or switch to azole agent (above) to complete 6 weeks
(3) therapy prior to delivery: intravenous amphotericin B daily
If the patient has no signs of coccidioidomycosis after 6 weeks then the prophylaxis can be discontinued, although ongoing monitoring should continue.
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Specialty: Infectious Diseases, Pharmacology, clinical