TABLE 2.

Options for treatment of blastomycosis

Agent	Comments
Amphotericin B	Used 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
Itraconazole	Preferred 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
Fluconazole	A 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
Ketoconazole	First azole proven to be effective; rarely used now
Voriconazole	Case 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
Posaconazole	May be effective, but there is very little clinical experience
Echinocandins	Poor to intermediate in vitro activity; should not be used