Antifungal agents benefits, weaknesses, and adverse effects in the treatment of Coccidioidomycosis Fluconazole - Benefits: Low cost/tolerable - Weaknesses: High MIC values in vitro - Side Effects: Hepatotoxicity, QTc prolongation, alopecia, xerosis, and cheilitis Itraconazole: - Benefits: Highly efficacious and tolerable - Weaknesses: CSF and bone penetration, TDM - Side Effects: Hepatotoxicity, gastrointestinal distress, hypertension, hypokalemia, negative inotrope, and peripheral edema Voriconazole: - Benefits: High CSF penetration - Weaknesses: Variable bioavailability and TDM - Side Effects: Hepatotoxicity, photopsia, and photoxic skin reactions, visual hallucinations, rashes/long-term use lead to skin carcinoma, alopecia, and xerosis Posaconazole: - Benefits: Penetrates most sites and effective against nonmeningeal coccidioidomycosis - Weaknesses: Therapeutic drug monitoring advised, low/variable CSF penetration - Side Effects: Gastrointestinal distress, hypokalemia, hypertension, peripheral edema Isavuconazole: - Benefits: Efficacious against primary coccidioidomycosis, prolonged half-life, and tolerable - Weaknesses: Limited clinical data against meningeal coccidioidomycosis - Side Effects: Gastrointestinal distress and hypokalemia AmBd: - Benefits: Intrathecal route - Weaknesses: Highly toxic - Side Effects: Nephrotoxicity, hepatotoxicity, hypokalemia, phlebitis, fever, chills, dyspnea, chest/back pain #Antifungal #agents #medications #Coccidioidomycosis #pharmacology #management #treatment #coccidioides
