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/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.