Ketoconazole for Treatment of Disseminated Coccidioidomycosis

Abstract

Of 29 selected patients with disseminated coccidioidomycosis, 27 were treated for at least 6 mo. with ketoconazole, 200-600 mg/days. Two patients had progression of coccidioidal disease shortly after starting ketoconazole and one developed meningitis. Of 8 patients, 7 with synovitis had prompt improvement in symptoms, but 4 had recurrent synovial thickening without recoverable Coccidioides immitis or could not remain free of symptoms off the drug. The response of osteomyelitis to ketoconazole was hard to assess; 3 of 8 cases clearly improved and none progressed. Abscess or sinus formation clearly improved in 8 of 10 patients; 5 remained free of disease after the drug was discontinued. Skin lesions improved in 6 of 9; 8 lesions remained healed off the drug. Ketoconazole is absorbed readily after oral ingestion and has little toxicity. In the dosages used, it seems to suppress but not eradicate C. immitis. The drug may be able to stabilize the infection while cell-mediated immunity is restored.