FLUCONAZOLE THERAPY FOR HISTOPLASMOSIS

We assessed the efficacy of oral. fluconazole (200-800 mg daily) in th e treatment of non-life-threatening acute pulmonary histoplasmosis, ch ronic pulmonary histoplasmosis, or disseminated histoplasmosis in pati ents without human immunodeficiency virus infection, Of 27 evaluable p atients, two had progressive acute pulmonary histoplasmosis, 11 had ch ronic pulmonary histoplasmosis, and 14 had disseminated histoplasmosis , Median durations of treatment in each of the three groups were 6 mon ths, 7 months, and 11 months, respectively. Nineteen patients were tre ated with 400 mg of fluconazole daily (two of these patients received 800 mg daily for a portion of their treatment courses), seven were tre ated with 200 mg daily, and one was treated with 800 mg daily, Treatme nt was successful in 17 (63%) of 27 cases. Both of the patients with a cute pulmonary infection responded to therapy, as did five (46%) of 11 patients with chronic pulmonary infection and 10 (71%) of 14 patients with disseminated infection, No substantial toxicity was observed. We conclude that fluconazole therapy for histoplasmosis is only moderate ly effective and should be reserved for patients who cannot take itrac onazole.