Intervention: Fluconazole
Trial phase: Phase 4
ATC code: D01AC15 | J01RA07 | J02AC01
SMILES: OC(Cn1cncn1)(Cn1cncn1)c1ccc(F)cc1F
Sex: All
Age groups: Adult | Older Adult
Healthy volunteers: No
Participants at risk: 72
Group description: Fluconazole was supplied as 200mg over encapsulated tablets. Each gelatin capsule contained two-100mg fluconazole tablets and microcrystalline cellulose for overfill. Fluconazole 400 mg (administered orally as two 200mg capsules) was to be taken once daily for a minimum of 42 days.
Eligibility criteria:
Inclusion Criteria:

Aged > / = 18 years and presenting for clinical care in coccidioidomycosis endemic areas.
Have a health care provider who has decided to treat community acquired pneumonia with antibacterials.
Be able to take and tolerate oral antibacterials/antifungals.
Able to understand the study and provide informed consent.
Willing and able to comply with study procedures and complete study visits.
Willing to allow access to medical records, and medical records are available to the study team.
The first dosage of study drug will be administered within 72 hours of presentation for care.
Able to swallow large pills.

Sexually active female subjects must be of non-childbearing potential* or, if of childbearing potential, must use a highly effective method of birth control**(captured on the appropriate data collection form).

*Non-childbearing potential is defined as being post-menopausal for at least 18 months or surgically sterile via bilateral oophorectomy or hysterectomy.

**Female subjects must avoid becoming pregnant by using one of the following acceptable methods of birth control for 30 days prior to study drug dosing and must be maintained for 30 days after last dose of study drug: i. Intrauterine contraceptive device; OR ii. Oral contraceptives; OR iii. Implanon, Nexplanon, DepoProvera, contraceptive skin patch or NuvaRing; OR iv. Tubal ligation; OR v. Exclusively same-sex relationships.

Non-pregnant female subjects of childbearing potential must have a negative pregnancy test within 24 hours prior to enrollment and at Visits 02 - 03.
Subjects receiving any of the drugs reported to have manageable drug interactions with fluconazole are allowed to be enrolled based on PI clinical judgment.

Exclusion Criteria:

Have recently received an experimental agent* or participating in or planning to participate in a study involving an experimental agent** while in the active drug administration phase of this study.

*defined as within 30 days prior to enrollment in this study.

**(e.g., vaccine, drug, biologic device, blood product, or medication).

Present clinical diagnosis of hospital acquired pneumonia (HAP).
Documented microbiologically- or serologically-confirmed past infection with coccidioidomycosis.
Clinical diagnosis of coccidioidal infection that is of sufficient certainty as to exclude the need for antibacterial therapy.

Have a history of systemic antibacterial treatment for this current CAP care episode occurring greater than 4 weeks prior to enrollment*.

*Receipt of systemic antimicrobial therapy for indications other than respiratory tract infection is permitted.

Have a history of systemic antifungal treatment within the 4 weeks prior to enrollment.

A single dose of fluconazole (ex. treatment of vulvovaginal candidiasis) is acceptable and should not exclude subject from study.

Long term use* of high dose oral or parenteral glucocorticoids**; or high-dose inhaled steroids*** taken within the 4 weeks prior to enrollment.

*defined as > 8 weeks of daily use.

**high dose defined as prednisone > / = 20 mg total daily dose, or equivalent dose of other glucocorticoids.

***high dose defined as > 800 mcg/day of beclomethasone dipropionate or equivalent

Have confirmed or suspected immunosuppression as a result of an underlying illness [other than well controlled HIV infection], primary immunodeficiency, or treatment, or induction/maintenance use of immunosuppressive agents*.

*including anti-neoplastic chemotherapy or cytotoxic radiation therapy for cancer, anti-TNF medications, or other immunomodulating agents.

History of a solid organ or bone marrow transplant.
Have poorly controlled HIV-infection or HIV-infection treated with Lopinavir, Tipranavir, Etravirine or Didanosine. Poorly controlled HIV is defined as HIV RNA > 50 copies/mm^3 (or greater than the lower limit of quantification [LLOQ] of the local HIV RNA assay if the LLOQ is > 50) in the 6 months prior to current care episode regardless of whether patient is on antiretroviral therapy or CD4 < 250 cell/mm^3.
Current diagnosis and/or treatment of active liver disease including abnormal baseline liver function tests as defined as: total bilirubin greater than or equal to 3.0 mg/dL AND either AST greater than or equal to 135 IU/L OR ALT greater than or equal to 150 IU/L.
On hemo or peritoneal dialysis or have a creatinine of > / = 2.0 mg/dL or estimated CrCl < /= 50 mL/min.
History of hypokalemia defined as less than 3.5 mEQ/L on more than one occasion during the 4 weeks prior to enrollment.
History of cardiovascular disease with increased risk for torsades de pointes as defined as: i. NYHA Heart Failure Criteria III or greater; OR ii. History of atrial or ventricular dysrhythmias; OR iii. History of structural heart disease (including previously repaired); OR iv.Personal or family history of congenital long QT syndrome.

A marked baseline prolongation of the QT/QTc interval defined as a QTc interval > 450 milliseconds (ms) for male subjects or > 470ms for female subjects with repeated demonstration*.

*Subjects without a history of prolonged QTc and an abnormal baseline QTc interval should undergo repeat ECG assessment within screening period prior to randomization (72 hours) to confirm prolongation. If the repeat ECG QTc is within normal limits and less than the parameters above, the subject may be considered for enrollment.

Pregnant or lactating females.
History of azole intolerance or allergy.
Individuals for whom study participation would not be in their best interest, as determined by the clinical investigator.
Are taking medications that are contraindicated with concurrent use of fluconazole.
Positive point of care HIV test at Day 1 visit consistent with new HIV diagnosis.