Azole therapy of clinical and experimental coccidioidomycosis.

The therapy of coccidioidomycosis has been an early target, both experimentally and clinically, for study of new members of the azole class of drugs, because of the recognition that coccidioidomycosis is one of the most difficult mycoses to treat, and because our research group and our collaborators have been eager to pioneer new therapies for this problem pathogen. There have been steady advances in the pharmacologic and antimicrobial properties of this class since the initial introduction of miconazole, and many patients with coccidioidomycosis have benefited. Perhaps the greatest contribution has been the development of well-tolerated oral drugs that make possible prolonged courses of a conveniently administered agent, and perhaps the most impressive advance has been the utility of the agents in coccidioidal meningitis, at least as an adjunct to the polyenes. More potent agents are still required, so that complete biological cure can be attained in meningeal and nonmeningeal coccidioidomycosis.