Treatment of choice for coccidioidomycosis is:
Amphotericin B (AMB) It is obtained from Streptomyces nodosus. Chemistry and mechanism of action The polyenes possess a macrocyclic ring, one side of which has several conjugated double bonds and is highly lipophilic, while the other side is hydrophilic with many OH groups. Antifungal spectrum AMB is active against a wide range of yeasts and fungi-Candida albicans, Histoplasma capsulatum, Cryptococcus neoformans, Blastomyces dermatitidis, Coccidioides immitis, Torulopsis, Rhodotorula, Aspergillus, Sporothrix, etc. Dermatophytes are inhibited in vitro, but concentrations of AMB attained in infected skin are low and ineffective. It is fungicidal at high and static at low concentrations. Resistance to AMB during therapy has been rarely noted among Candida in a selected group of leucopenic cancer patients, but it is not a problem in the clinical use of the drug. AMB is also active on various species of Leishmania. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:757,758
Amphotericin
Fluconazole
Flucytosine
Griseofulvin
Chemotherapy