What is the first line treatment for Mild to Moderate Blastomycosis?

The first-line treatment for mild to moderate blastomycosis is itraconazole. This antifungal medication is effective against Blastomyces dermatitidis, the fungus responsible for the infection. Itraconazole is favored for its oral route of administration, tolerability, and lower toxicity compared to other options such as amphotericin B, which is more commonly used for severe or life-threatening fungal infections.

In cases of mild to moderate disease, itraconazole provides adequate coverage, promotes recovery, and allows for outpatient management, which is generally safer and more convenient for patients. It also has a favorable pharmacokinetic profile and is considered the standard of care for non-severe cases of blastomycosis.

While alternatives like oral fluconazole and oral ketoconazole are antifungals, they are not typically used as first-line treatments for blastomycosis. Fluconazole is better suited for infections caused by Candida species, and ketoconazole has largely fallen out of favor due to safety concerns and less efficacy compared to newer agents. Amphotericin B is reserved for more severe infections or cases where patients cannot tolerate oral medications, making itraconazole the best choice for mild to moderate cases.