{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T08:22:51Z","timestamp":1776414171467,"version":"3.51.2"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with pulmonary coccidioidomycosis often experience prolonged symptoms lasting from weeks to months. Limited data exist regarding whether fluconazole prevents development of disseminated disease or shortens symptom duration. We describe factors associated with fluconazole receipt and assess its effect on outcomes among patients with pulmonary coccidioidomycosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the MerativeTM MarketScan\u00ae Commercial Database, we identified immunocompetent patients ages 18\u201364 with incident pulmonary coccidioidomycosis during 2017\u20132023 and continuous enrollment in the 180 days before and after diagnosis. We examined demographic and clinical differences between patients treated versus not treated with fluconazole and performed 1:1 greedy nearest neighbor propensity score matching to control for these differences. We performed bivariate analyses on the matched subset to evaluate patient outcomes by fluconazole receipt.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1448 patients with pulmonary coccidioidomycosis, 659 (46%) received fluconazole. Patients who received fluconazole more frequently had pre-diagnosis symptoms (95% vs 72%, P &amp;lt; .001) and antibiotic prescriptions (68% vs 32%, P &amp;lt; .001) than those who did not. Among the propensity score matched subset (n = 696), hospitalization (4% vs 1%, P = .004) and disseminated coccidioidomycosis (3% vs 0%, P = .006) were more frequent among patients who received fluconazole. The median number of days from diagnosis to last visit for chest pain (50.0 vs 46.5), cough (64.0 vs 39.0), fatigue (63.0 vs 65.5), myalgia (98.0 vs 74.0), and joint pain (93.5 vs 107.5) was not significantly different between treatment groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our results support existing guidelines that fluconazole may not be associated with improved outcomes for certain immunocompetent patients with pulmonary coccidioidomycosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciaf036","type":"journal-article","created":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T15:18:32Z","timestamp":1737472712000},"page":"e515-e522","source":"Crossref","is-referenced-by-count":2,"title":["Impact of Fluconazole on Outcomes of Patients With Primary Pulmonary Coccidioidomycosis: A Commercial Health Insurance Claims-based, Propensity Score Matched Analysis"],"prefix":"10.1093","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0458-2493","authenticated-orcid":false,"given":"Kaitlin","family":"Benedict","sequence":"first","affiliation":[{"name":"Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta , ,","place":["Georgia USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8807-9566","authenticated-orcid":false,"given":"Ian","family":"Hennessee","sequence":"additional","affiliation":[{"name":"Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta , ,","place":["Georgia USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5707-528X","authenticated-orcid":false,"given":"Dallas J","family":"Smith","sequence":"additional","affiliation":[{"name":"Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta , ,","place":["Georgia USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5904-6658","authenticated-orcid":false,"given":"Mitsuru","family":"Toda","sequence":"additional","affiliation":[{"name":"Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta , ,","place":["Georgia USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George 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