Tratamiento de la Coccidioidomicosis Pulmonar Aguda con Síntomas Leves o No Debilitantes (Presentación No Complicada, Sin Inmunosupresión)
Este protocolo se aplica a adultos con neumonía coccidioidea no complicada cuyos síntomas son leves o no debilitantes —o cuya enfermedad clínica ha mejorado sustancialmente o se ha resuelto en el momento del diagnóstico— y que no presentan ninguna condición inmunosupresora manifiesta.
Escenario Clínico
Neumonía coccidioidea no complicada con síntomas leves o no debilitantes, o enfermedad clínica sustancialmente mejorada o resuelta en el momento del diagnóstico; sin condición inmunosupresora manifiesta.
Objetivos del Tratamiento
Resolución de signos, síntomas y marcadores inflamatorios, con estabilización de serologías y radiografías de tórax.
References
DOI: 10.1093/cid/ciw360
- We recommend patient education, close observation, and supportive measures such as reconditioning physical therapy for patients who appear to have mild or nondebilitating symptoms, or who have substantially improved or resolved their clinical illness by the time of diagnosis (strong, low).
- If treatment is begun in nonpregnant adults, the treatment should be an orally absorbed azole antifungal (eg, fluconazole) at a daily dose of ≥400 mg (strong, low).
- If treatment of early uncomplicated coccidioidal infection is instituted, the usual dose for adults is 400 mg daily. Some experts would recommend 800 mg daily.
- The duration is not certain, although many experts would recommend a treatment duration ranging from 3 to 6 months or longer, depending on the clinical response.
- Treatment can be discontinued when the patient's signs, symptoms, and inflammatory markers have resolved, and serologies and radiographs have stabilized.