Sporotrichosis medical therapy

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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 PO qd	Itraconazole 200 mg PO bid, OR Terbinafine [500 mg PO bid], OR SSKI increasing doses], OR Fluconazole [400-800 mg PO qd], 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 PO qd] OR deoxycholate amphotericin B [0.7-1 mg/kg PO qd] 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 PO qd], THEN followed by itraconazole [200 mg PO bid]	Deoxycholate amphotericin B [0.7-1 mg/kg PO qd], 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 PO qd], THEN followed by itraconazole [200 mg PO bid]	Deoxycholate amphotericin B [0.7-1 mg/kg PO qd], 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 PO qd], THEN followed by itraconazole [200 mg PO bid.]	Deoxycholate amphotericin B [0.7-1 mg/kg PO qd], 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 PO qd] OR deoxycholate amphotericin B [0.7-1 mg/kg PO qd] 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 PO qd to a max of 400 mg PO qd] for mild cases Deoxycholate amphotericin B [0.7-1 mg/kg PO qd] for severe cases	SSKI [increasing doses equivalent to half the adult dose], continuing treatment for 2-4 weeks after resolution of symptoms.