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.


To read more or access our algorithms and calculators, please log in or register.