What treatment option is first-line for chronic, uncomplicated Coccidioidomycosis if symptoms persist?

Fluconazole is considered the first-line treatment for chronic, uncomplicated Coccidioidomycosis when symptoms persist. This choice is supported by the drug’s efficacy in targeting the specific fungal pathogen responsible for coccidioidomycosis, Coccidioides immitis, and its ability to penetrate body tissues effectively. Fluconazole has a proven track record of providing good clinical response with a favorable safety profile for long-term use, which is critical in chronic cases.

Other options, while they may have their uses in different contexts or for more severe forms of fungal infections, are not the preferred initial treatment for chronic, uncomplicated Coccidioidomycosis. For example, Amphotericin B is usually reserved for more serious or disseminated fungal infections due to its toxicity and potential side effects. IV Echinocandins are more appropriate for certain molds or candidiasis but are not typically effective against Coccidioides. Itraconazole can also be used in some cases, but fluconazole is often preferred due to its established effectiveness and tolerability in treating this specific condition.