TABLE 2.

Options for treatment of blastomycosis

AgentComments
Amphotericin BUsed for patients with moderately severe to severe disease, those with central nervous system involvement, those who are immunocompromised, and those who are pregnant; lipid formulations are preferable in some situations
ItraconazolePreferred agent for patients with mild to moderate disease and as step-down therapy for those with more severe disease who have received amphotericin B; oral solution provides more consistent serum levels than capsules
FluconazoleA second-line agent that is less efficacious than itraconazole; an option for step-down therapy after a course of amphotericin B for central nervous system infection
KetoconazoleFirst azole proven to be effective; rarely used now
VoriconazoleCase reports, in vitro studies, and animal studies support its use; no prospective human trials; an option for step-down therapy after a course of amphotericin B for central nervous system infection
PosaconazoleMay be effective, but there is very little clinical experience
EchinocandinsPoor to intermediate in vitro activity; should not be used