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