Sporotrichosis medical therapy: Difference between revisions

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|Uncomplicated cutaneous
|Uncomplicated cutaneous
|Itraconazole [200 mg/day]
|
|Itraconazole [200 mg b.i.d.], terbinafine [500 b.i.d.], SSKI [increasing doses], fluconazole [400-800 mg/day], or local hyperthermia
* Itraconazole [200 mg/day]
|
* Itraconazole [200 mg PO bid],  
* terbinafine [500 mg PO bid],  
* SSKI [increasing doses],
* fluconazole [400-800 mg/day],  
* '''<u>OR</u>''' local hyperthermia
|Continue treatment for 2-4 weeks after lesions resolve.
|Continue treatment for 2-4 weeks after lesions resolve.
|-
|-
|Osteoarticular
|Osteoarticular
|Itraconazole [200 mg b.i.d.]
|
|Limposomal amphotericin B [3-5 mg/kg/day] or deoxycholate amphotericin B [0.7-1 mg/kg/day] until symptom resolution
* Itraconazole [200 mg PO bid]
|
* Limposomal amphotericin B [3-5 mg/kg/day]  
* '''<u>OR</u>''' deoxycholate amphotericin B [0.7-1 mg/kg/day] until symptom resolution
|For a total of 12 months, switch to itraconazole after resolution/end of treatment.
|For a total of 12 months, switch to itraconazole after resolution/end of treatment.
|-
|-
|Pulmonary
|Pulmonary
|Limposomal amphotericin B [3-5 mg/kg/day], followed by itraconazole [200 mg b.i.d.]
|
|Deoxycholate amphotericin B [0.7-1 mg/kg/day], followed by itraconazole [200 mg b.i.d.] upon symptom resolution
* Limposomal amphotericin B [3-5 mg/kg/day],  
* '''<u>THEN</u>''' followed by itraconazole [200 mg PO bid]
|
* Deoxycholate amphotericin B [0.7-1 mg/kg/day],  
* '''<u>THEN</u>''' followed by itraconazole [200 mg PO bid] upon symptom resolution
|Treat less sever cases with a 12 month regimen of itraconazole.
|Treat less sever cases with a 12 month regimen of itraconazole.
|-
|-
|Meningeal
|Meningeal
|Limposomal amphotericin B [3-5 mg/kg/day], followed by itraconazole [200 mg b.i.d.]
|
|Deoxycholate amphotericin B [0.7-1 mg/kg/day], followed by itraconazole [200 mg b.i.d.] upon symptom resolution
* Limposomal amphotericin B [3-5 mg/kg/day],  
* '''<u>THEN</u>''' followed by itraconazole [200 mg PO bid]
|
* Deoxycholate amphotericin B [0.7-1 mg/kg/day],  
* '''<u>THEN</u>''' followed by itraconazole [200 mg PO bid] upon symptom resolution
|Precise length of amphotericin B treatment varies. Suppressive treatment with itraconazole is necessary.  
|Precise length of amphotericin B treatment varies. Suppressive treatment with itraconazole is necessary.  
|-
|-
|Dissimated
|Dissimated
|Limposomal amphotericin B [3-5 mg/kg/day], followed by itraconazole [200 mg b.i.d.]
|
|Deoxycholate amphotericin B [0.7-1 mg/kg/day], followed by itraconazole [200 mg b.i.d.] upon symptom resolution
* Limposomal amphotericin B [3-5 mg/kg/day],  
* '''<u>THEN</u>''' followed by itraconazole [200 mg PO bid.]
|
* Deoxycholate amphotericin B [0.7-1 mg/kg/day],  
* '''<u>THEN</u>''' followed by itraconazole [200 mg PO bid] upon symptom resolution
|Continue amphotericin B treatment until patient shows marked improvement for a minimum of 12 months. Suppressive treatment with itraconazole is necessary.
|Continue amphotericin B treatment until patient shows marked improvement for a minimum of 12 months. Suppressive treatment with itraconazole is necessary.
|-
|-
|Sporotrichosis in pregnant women
|Sporotrichosis in pregnant women
| colspan="2" |Treat with limposomal amphotericin B [3-5 mg/kg/day] or deoxycholate amphotericin B [0.7-1 mg/kg/day] only for severe cases of sporotrichosis.
| colspan="2" |
 
* Treat with limposomal amphotericin B [3-5 mg/kg/day]  
In cases of uncomplicated cutaneous, treat with only hyperthermia.
* '''<u>OR</u>''' deoxycholate amphotericin B [0.7-1 mg/kg/day] only for severe cases of sporotrichosis.
* In cases of uncomplicated cutaneous, treat with only hyperthermia.


|It is preferable to defer treatment in uncomplicated cases.  
|It is preferable to defer treatment in uncomplicated cases.  
|-
|-
|Sporotrichosis in Children
|Sporotrichosis in Children
|Itraconazole [6-10 mg/day to a max of 400 mg] for mild cases
|
Deoxycholate amphotericin B [0.7-1 mg/kg/day] for severe cases
* Itraconazole [6-10 mg/day to a max of 400 mg] for mild cases
|SSKI [increasing doses equivalent to half the adult dose], continuing treatment for 2-4 weeks after resolution of symptoms.  
* Deoxycholate amphotericin B [0.7-1 mg/kg/day] for severe cases
|
* SSKI [increasing doses equivalent to half the adult dose], continuing treatment for 2-4 weeks after resolution of symptoms.
|
|
|}
|}

Revision as of 13:53, 13 January 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alison Leibowitz [2]

Treatment

Form Primary Line of Treatment Alternative Treatment Remarks/Other
Uncomplicated cutaneous
  • Itraconazole [200 mg/day]
  • Itraconazole [200 mg PO bid],
  • terbinafine [500 mg PO bid],
  • SSKI [increasing doses],
  • fluconazole [400-800 mg/day],
  • OR local hyperthermia
Continue treatment for 2-4 weeks after lesions resolve.
Osteoarticular
  • Itraconazole [200 mg PO bid]
  • Limposomal amphotericin B [3-5 mg/kg/day]
  • OR deoxycholate amphotericin B [0.7-1 mg/kg/day] until symptom resolution
For a total of 12 months, switch to itraconazole after resolution/end of treatment.
Pulmonary
  • Limposomal amphotericin B [3-5 mg/kg/day],
  • THEN followed by itraconazole [200 mg PO bid]
  • Deoxycholate amphotericin B [0.7-1 mg/kg/day],
  • THEN followed by itraconazole [200 mg PO bid] upon symptom resolution
Treat less sever cases with a 12 month regimen of itraconazole.
Meningeal
  • Limposomal amphotericin B [3-5 mg/kg/day],
  • THEN followed by itraconazole [200 mg PO bid]
  • Deoxycholate amphotericin B [0.7-1 mg/kg/day],
  • THEN followed by itraconazole [200 mg PO bid] upon symptom resolution
Precise length of amphotericin B treatment varies. Suppressive treatment with itraconazole is necessary.
Dissimated
  • Limposomal amphotericin B [3-5 mg/kg/day],
  • THEN followed by itraconazole [200 mg PO bid.]
  • Deoxycholate amphotericin B [0.7-1 mg/kg/day],
  • THEN followed by itraconazole [200 mg PO bid] upon symptom resolution
Continue amphotericin B treatment until patient shows marked improvement for a minimum of 12 months. Suppressive treatment with itraconazole is necessary.
Sporotrichosis in pregnant women
  • Treat with limposomal amphotericin B [3-5 mg/kg/day]
  • OR deoxycholate amphotericin B [0.7-1 mg/kg/day] only for severe cases of sporotrichosis.
  • In cases of uncomplicated cutaneous, treat with only hyperthermia.
It is preferable to defer treatment in uncomplicated cases.
Sporotrichosis in Children
  • Itraconazole [6-10 mg/day to a max of 400 mg] for mild cases
  • Deoxycholate amphotericin B [0.7-1 mg/kg/day] for severe cases
  • SSKI [increasing doses equivalent to half the adult dose], continuing treatment for 2-4 weeks after resolution of symptoms.

[1]

References

  1. Kauffman CA, Bustamante B, Chapman SW, Pappas PG, Infectious Diseases Society of America (2007). "Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America". Clin Infect Dis. 45 (10): 1255–65. doi:10.1086/522765. PMID 17968818.