Treatment of Moderately Severe to Severe Pulmonary Blastomycosis in Immunocompetent Adults (Age 18+)

This protocol applies to an immunocompetent adult aged 18 years or older presenting with moderately severe to severe pulmonary blastomycosis who is not immunosuppressed. Disease severity drives the treatment strategy for this population.

Clinical Scenario

Moderately severe to severe pulmonary blastomycosis in an immunocompetent adult (age 18 years or older), not immunosuppressed. The severity of presentation distinguishes this scenario from mild disease and dictates a more intensive initial approach.

Treatment Approach (partial overview)

Management involves an initial course of intravenous antifungal therapy, followed by a step-down to prolonged oral antifungal treatment. The full protocol — including specific agents, sequencing, and total treatment duration — is available in the structured regimen below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1086/588300

For moderately severe to severe disease, initial treatment with a lipid formulation of AmB at a dosage of 3–5 mg/kg per day or AmB deoxycholate at a dosage of 0.7–1 mg/kg per day for 1–2 weeks or until improvement is noted, followed by oral itraconazole, 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 6–12 months, is recommended (A-III).

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