Choosing the best histoplasmosis treatment for you typically depends on what form of the disease you have. If you have an acute infection that is not causing any symptoms, or very mild ones, treatment may not even be necessary. If you are experiencing severe symptoms like pericarditis or difficulty breathing in response to the infection, or if your histoplasmosis has become chronic or spread beyond your lungs to other parts of the body, your doctor will likely give you anti-fungal medication. The drug or drugs you are given will depend on your general health and the severity of your infection. You may also receive corticosteroids to help with respiratory distress.
Many people with histoplasmosis never even know they have it, as it may be asymptomatic. Others can have mild symptoms that resolve on their own. In these cases, there is no histoplasmosis treatment needed.
For patients whose illness is more severe, histoplasmosis treatment typically includes the use of anti-fungal drugs. The two most common are amphotericin B and itraconazole. Amphotericin B is more powerful and may be your best first choice if you have a severe infection, though it can have negative effects so your doctor may limit your time on the drug and follow it up with itraconazole. If you have a milder infection, itraconazole alone may be enough to cure it. Patients who cannot tolerate either of these medications may be given another anti-fungal called fluconazole, though it is often less effective and therefore not the preferred treatment.
In addition to the type of infection you have and how severe it is, your doctor may need to look at your overall health and certain medical conditions to determine your best option for histoplasmosis treatment. Amphotericin B administered intravenously is typically considered the best treatment for severe or disseminated forms of the disease, but can be very damaging to the kidneys, so if you have kidney problems it may not be an option. Itraconazole causes fewer problems and side effects, but takes longer to work and still may not be well-tolerated, in which case your doctor may recommend fluconazole.
Since the Histoplasma capsulatum fungus typically attacks the lungs, you may experience difficulty breathing from the infection. If this is the case, you may need to take corticosteroids temporarily as part of histoplasmosis treatment to reduce the inflammation in your lungs. These drugs can be discontinued once the anti-fungals start working and your symptoms subside.