American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the treatment strategy for disseminated coccidioidomycosis?

1. Amphotericin B only

2. Itraconazole for 6 months

3. Lipid formulation of amphotericin B followed by itraconazole or fluconazole

4. Fluconazole for 6-12 months

The correct answer is: Lipid formulation of amphotericin B followed by itraconazole or fluconazole

The treatment strategy for disseminated coccidioidomycosis involves the use of antifungal therapies that are effective against this specific fungal infection. The correct approach typically includes the initial administration of a lipid formulation of amphotericin B, which is particularly beneficial in cases of severe or disseminated disease due to its potent antifungal activity. This is followed by a transition to either itraconazole or fluconazole. Lipid formulations of amphotericin B are preferred over conventional amphotericin B because they have a reduced risk of nephrotoxicity and can better penetrate tissues, making them more effective in treating disseminated infections. Once the acute phase is controlled with higher levels of antifungal therapy, transitioning to oral therapies like itraconazole or fluconazole provides a good long-term management strategy, allowing the patient to continue treatment with fewer side effects. Duration of treatment generally lasts several months, depending on the individual case's severity and clinical response. This combination approach ensures that both immediate control of the acute infection and longer-term maintenance therapy are effectively addressed.