Sporotrichosis medical therapy: Difference between revisions

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{{CMG}}; {{AE}} {{AJL}}
{{CMG}}; {{AE}} {{AJL}}
==Overview==
Because spontaneous resolution in cases of sporotrichosis is a rarity, the majority of patients require treatment. The recommended treatment regimens are largely empirical and predominantly based upon retrospective evaluations, case study reports, and nonrandomized control trials. The predominant therapy for sporotrichosis is [[itraconazole]], which is used as the primary treatment in [[immunocompetent]] patients, and as a suppressive therapy in [[Immunocompromised host|immunocompromised patients]]. The primary line of treatment for  [[Immunocompromised host|immunocompromised patients]] is [[amphotericin B]].


==Treatment==
==Treatment==
{| class="wikitable"
Because spontaneous resolution in cases of sporotrichosis is a rarity, the majority of patients require treatment. The recommended treatment regimens are largely empirical and predominantly based upon retrospective evaluations, case study reports, and nonrandomized control trials.<ref name="pmid17968818">{{cite journal| author=Kauffman CA, Bustamante B, Chapman SW, Pappas PG, Infectious Diseases Society of America| title=Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2007 | volume= 45 | issue= 10 | pages= 1255-65 | pmid=17968818 | doi=10.1086/522765 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17968818  }} </ref>
!Form
The chart below outlines the effective treatment methods based upon the form of sporotrichosis displayed by an infected human host.
!Primary Line of Treatment
{| class="wikitable" style="border: 0px; font-size: 90%; margin: 3px; width: 80%" align="center" |
!Alternative Treatment
 
!Remarks/Other
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Form}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Primary Line of Treatment}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Alternative Treatment}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Remarks/Other}}
|-
|-
|Uncomplicated cutaneous
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Uncomplicated cutaneous
|Itraconazole [200 mg/day]
| style="padding: 5px 5px; background: #F5F5F5;" |
|Itraconazole [200 b.i.d.], terbinafine [500 b.i.d.], SSKI [increasing doses], fluconazole [400-800 mg/day], or local hyperthermia
* [[Itraconazole]] 200 mg PO qd
|Continue treatment for 2-4 weeks after lesions resolve.
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Itraconazole]] 200 mg PO bid, {{Or}}
* [[Terbinafine]] 500 mg PO bid, {{Or}}
* [[Potassium iodide|SSKI]] increasing doses from 5 drops tid for one month to 40-50 drops qd, {{Or}}
* [[Fluconazole]] 400-800 mg PO qd, {{Or}}
* Local [[hyperthermia]]
| style="padding: 5px 5px; background: #F5F5F5;" |Continue treatment for 2-4 weeks after lesions resolve.
|-
|-
|Osteoarticular
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Osteoarticular
|Itraconazole [200 mg b.i.d.]
| style="padding: 5px 5px; background: #F5F5F5;" |
|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
|For a total of 12 months, switch to itraconazole after resolution/end of treatment.
| style="padding: 5px 5px; background: #F5F5F5;" |
* Limposomal [[amphotericin B]] 3-5 mg/kg IV qd '''<u>OR</u>'''
* Deoxycholate [[amphotericin B]] 0.7-1 mg/kg IV qd until symptom resolution
| style="padding: 5px 5px; background: #F5F5F5;" |For a total of 12 months, switch to [[Itraconazole]] after resolution/end of treatment.
|-
|-
|Pulmonary
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Pulmonary
|Limposomal amphotericin B [3-5 mg/kg/day], followed by itraconazole [200 mg b.i.d.]
| style="padding: 5px 5px; background: #F5F5F5;" |
|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 IV qd '''<u>THEN</u>'''
|Treat less sever cases with a 12 month regimen of itraconazole.
* [[Itraconazole]] 200 mg PO bid
| style="padding: 5px 5px; background: #F5F5F5;" |
* Deoxycholate [[amphotericin B]] 0.7-1 mg/kg IV qd '''<u>THEN</u>'''
* [[Itraconazole]] 200 mg PO bid upon symptom resolution
| style="padding: 5px 5px; background: #F5F5F5;" |Treat less sever cases with a 12 month regimen of [[Itraconazole]].
|-
|-
|Meningeal
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Meningeal
|Limposomal amphotericin B [3-5 mg/kg/day], followed by itraconazole [200 mg b.i.d.]
| style="padding: 5px 5px; background: #F5F5F5;" |
|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 IV qd '''<u>THEN</u>'''
|Precise length of amphotericin B treatment varies. Suppressive treatment with itraconazole is necessary.  
* [[Itraconazole]] 200 mg PO bid
| style="padding: 5px 5px; background: #F5F5F5;" |
* Deoxycholate [[amphotericin B]] 0.7-1 mg/kg IV qd '''<u>THEN</u>'''
* [[Itraconazole]] 200 mg PO bid upon symptom resolution
| style="padding: 5px 5px; background: #F5F5F5;" |Precise length of [[amphotericin B]] treatment varies. Suppressive treatment with [[Itraconazole]] is necessary.  
|-
|-
|Dissimated
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Dissimated
|Limposomal amphotericin B [3-5 mg/kg/day], followed by itraconazole [200 mg b.i.d.]
| style="padding: 5px 5px; background: #F5F5F5;" |
|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 IV qd '''<u>THEN</u>'''
|Continue amphotericin B treatment until patient shows marked improvement for a minimum of 12 months. Suppressive treatment with itraconazole is necessary.
* [[Itraconazole]] 200 mg PO bid.
| style="padding: 5px 5px; background: #F5F5F5;" |
* Deoxycholate [[amphotericin B]] 0.7-1 mg/kg IV qd '''<u>THEN</u>'''
* [[Itraconazole]] 200 mg PO bid upon symptom resolution  
| style="padding: 5px 5px; background: #F5F5F5;" |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
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |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" style="padding: 5px 5px; background: #F5F5F5;" |
 
* Treat with limposomal [[amphotericin B]] 3-5 mg/kg IV qd '''<u>OR</u>'''
In cases of uncomplicated cutaneous, treat with only hyperthermia.
* Deoxycholate [[amphotericin B]] 0.7-1 mg/kg IV qd only for severe cases of sporotrichosis '''<u>OR</u>'''
* In cases of uncomplicated cutaneous, treat with only hyperthermia.


|It is preferable to defer treatment in uncomplicated cases.  
| style="padding: 5px 5px; background: #F5F5F5;" |It is preferable to defer treatment in uncomplicated cases.  
|-
|-
|Sporotrichosis in Children
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Sporotrichosis in Children
|
| style="padding: 5px 5px; background: #F5F5F5;" |
|
* [[Itraconazole]] 6-10 mg PO qd to a max of 400 mg PO qd for mild cases '''<u>OR</u>'''
* Deoxycholate [[amphotericin B]] 0.7-1 mg/kg IV qd for severe cases
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Potassium iodide|SSKI]] increasing doses equivalent to half the adult dose, continuing treatment for 2-4 weeks after resolution of symptoms.
|
|
|}
|}
<ref name="pmid17968818">{{cite journal| author=Kauffman CA, Bustamante B, Chapman SW, Pappas PG, Infectious Diseases Society of America| title=Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2007 | volume= 45 | issue= 10 | pages= 1255-65 | pmid=17968818 | doi=10.1086/522765 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17968818  }} </ref> <ref name="pmid21976602">{{cite journal| author=Barros MB, de Almeida Paes R, Schubach AO| title=Sporothrix schenckii and Sporotrichosis. | journal=Clin Microbiol Rev | year= 2011 | volume= 24 | issue= 4 | pages= 633-54 | pmid=21976602 | doi=10.1128/CMR.00007-11 | pmc=PMC3194828 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21976602  }} </ref>


==References==
==References==
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Infectious disease]]
 
[[Category:Infectious Disease Project]]
[[Category:Infectious Disease Project]]

Latest revision as of 19:06, 18 September 2017

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

Overview

Because spontaneous resolution in cases of sporotrichosis is a rarity, the majority of patients require treatment. The recommended treatment regimens are largely empirical and predominantly based upon retrospective evaluations, case study reports, and nonrandomized control trials. The predominant therapy for sporotrichosis is itraconazole, which is used as the primary treatment in immunocompetent patients, and as a suppressive therapy in immunocompromised patients. The primary line of treatment for immunocompromised patients is amphotericin B.

Treatment

Because spontaneous resolution in cases of sporotrichosis is a rarity, the majority of patients require treatment. The recommended treatment regimens are largely empirical and predominantly based upon retrospective evaluations, case study reports, and nonrandomized control trials.[1] The chart below outlines the effective treatment methods based upon the form of sporotrichosis displayed by an infected human host.

Form Primary Line of Treatment Alternative Treatment Remarks/Other
Uncomplicated cutaneous Continue treatment for 2-4 weeks after lesions resolve.
Osteoarticular For a total of 12 months, switch to Itraconazole after resolution/end of treatment.
Pulmonary Treat less sever cases with a 12 month regimen of Itraconazole.
Meningeal
  • Limposomal amphotericin B 3-5 mg/kg IV qd THEN
  • Itraconazole 200 mg PO bid
 Precise length of amphotericin B treatment varies. Suppressive treatment with Itraconazole is necessary.
Dissimated
  • Limposomal amphotericin B 3-5 mg/kg IV qd THEN
  • Itraconazole 200 mg PO bid.
 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 IV qd OR
  • Deoxycholate amphotericin B 0.7-1 mg/kg IV qd only for severe cases of sporotrichosis OR
  • 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 OR
  • Deoxycholate amphotericin B 0.7-1 mg/kg IV qd for severe cases
  • SSKI increasing doses equivalent to half the adult dose, continuing treatment for 2-4 weeks after resolution of symptoms.

[1] [2]

References

  1. ↑ 1.0 1.1 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.
  2. ↑ Barros MB, de Almeida Paes R, Schubach AO (2011). "Sporothrix schenckii and Sporotrichosis". Clin Microbiol Rev. 24 (4): 633–54. doi:10.1128/CMR.00007-11. PMC 3194828. PMID 21976602.
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