Antifungal Prophylaxis for Coccidioidomycosis: How Long Is Long Enough?

The study by Gupta et al. examines the necessity of prolonged antifungal prophylaxis for coccidioidomycosis in transplant recipients. It highlights that transplant recipients in endemic areas are at risk for coccidioidomycosis, and antifungal prophylaxis, primarily with fluconazole, has been effective in reducing this risk. However, prolonged use can lead to side effects and drug interactions. The study involved 77 recipients who discontinued fluconazole due to adverse effects or noncompliance, with no subsequent development of coccidioidomycosis, suggesting that stopping prophylaxis after 1 year may be reasonable for low-risk patients with only EIA-IgM positivity. The authors propose that innovations such as new antifungal drugs, improved diagnostic assays, and vaccines could reduce the need for long-term prophylaxis.